Pneumocephalus – Epidural Injection Nightmare

Pneumocephalus (pneumatocele or intracranial aerocele) is defined as the presence of air in the intracranial space and most commonly occurs after a traumatic event (most commonly head or facial injury), epidural injection, cranial surgery, However, it may also be spontaneous. Classified into simple and tension types, the presentation varies based on severity and progression. Pneumocephalus with onset less than 72 hours prior to presentation is defined as acute, in contrast to a delayed presentation greater than the given timeframe. Symptoms vary based on the amount of air that is present as well as the exact location within the cranial cavity. Large accumulations of intracranial air can lead to headache, nausea, dizziness or neurologic deficit. The condition is a medical emergency and management can be challenging as pneumocephalus can resemble other neurologic conditions. Diagnostic procedures such as epidural injection have been associated with pneumocephalus development. Non-traumatic pneumocephalus can be secondary to bony defect, malformations, infection, tumor, and intravenous air injection. Here we present the case of a 42-year-old patient who presented to the ED with a new onset seizure and a history of a recent epidural cervical spine injection for pain management purposes.