Pneumocephalus and Seizures Following Combined Spinal-epidural for Labor

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(J Clin Anesth. 2018;44:123–124)In this correspondence, the authors described a patient who presented with simultaneous pneumocephalus and cavernoma after receiving combined spinal-epidural analgesia for labor. However, unlike most cases of combined spinal-epidural analgesia for labor, which use loss of resistance to air to identify the epidural space, the authors used loss of resistance to saline. To the author’s knowledge, there are no published reports of the use of loss of resistance to saline for this purpose. Identification of the epidural space was successful upon the fourth attempt with the patient in a sitting position. Upon injection of local anesthetic, the patient immediately complained of a severe headache, that was unremitting with postural changes and continued into the postpartum period. On postpartum day 2, the patient presented with a tonic-clonic seizure. Magnetic resonance imaging showed intraventricular pneumocephalus and cavernoma in the right frontal region, and electroencephalogram showed abundant epileptic activity. Oxygen was added to the patient’s therapy with clinical improvement; complete reabsorption of air on radiologic examination was seen on the sixth day and the asymptomatic patient was discharged.

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