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Abstract Details

Thunderclap Headache Associated with Pneumocephalus in Epidural Anesthesia
Headache
P06 - (-)
152
BACKGROUND: Headache resulting from dural puncture is almost always secondary to a cerebrospinal fluid leak and occurs post epidural anesthesia. Pneumocephalus may rarely occur in this setting but the pattern of headache and neurological deficits have not been well-described when occurring after dural puncture.
DESIGN/METHODS: Case report from a tertiary medical center.
RESULTS: A 30 year old healthy woman with a history of infrequent migraine without aura underwent lumbar epidural anesthesia for a delivery at term. Within seconds of catheter insertion she experienced a sudden, explosive, maximal at onset right frontal headache and neck pain, remarkably worse during recumbency but improved when upright. After an uneventful delivery she developed right ptosis, mydriasis, and binocular vertical diplopia on left gaze. Examination was notable for nuchal rigidity and a right third cranial nerve palsy. Brain MRI revealed air (pneumocephalus) in the left lateral ventricle and suprasellar cistern. The patient's headache and ophthalmoparesis resolved with high flow oxygen and nonsteroidal anti-inflammatory agents.
CONCLUSIONS: Pneumocephalus following inadvertent intrathecal air administration should be considered as a possible etiology of thunderclap headache in the setting of epidural anesthesia. Clinical clues to the diagnosis that distinguish the syndrome from a CSF leak may include a severe headache at the onset of catheter insertion rather than a delayed pattern, and a headache that exacerbates in recumbency but abates when upright, which could reflect air recirculation to structures that are particularly pain sensitive or obstruct CSF flow.
Authors/Disclosures
Valentyna Honchar, MD (Capital Neurology)
PRESENTER 		No disclosure on file
Jose E. Cavazos, MD, PhD (U Texas Health San Antonio) Dr. Cavazos has received stock or an ownership interest from Brain Sentinel . The institution of Dr. Cavazos has received research support from NIH.
No disclosure on file
Matthew S. Robbins, MD, FAAN (Weill Cornell Medicine) Dr. Robbins has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Robbins has received publishing royalties from a publication relating to health care. Dr. Robbins has a non-compensated relationship as a Board of Directors member, 好色先生 Program speaker with American Headache Society that is relevant to AAN interests or activities. Dr. Robbins has a non-compensated relationship as a Board of Directors member, 好色先生 Program speaker with New York State Neurological Society that is relevant to AAN interests or activities. Dr. Robbins has a non-compensated relationship as a Editorial Board Member with Continuum, 好色先生 that is relevant to AAN interests or activities.