Pneumocephalus and Seizure in Patient after Epidural Lumbar Puncture: Case Report

Lumbar epidural analgesia is using widely as an alternative method for anesthesia. Although it has its benefits such as the low risk of complications in contrast with general anesthesia, also it has some adverse effects, for instance: headache, loss of consciousness, pneumocephalus, dizziness, and seizure. Pneumocephalus is a rare complication of lumbar epidural block. In this case of study, a patient represents stenosis in the site of anastomosis of colon and duodenum candidate for a repair surgery with the lumbar epidural block. Epidural catheter insertion was done in the sitting position; local anesthesia was administered at the 4th and 5th lumbar vertebral interspace. A 17-gauge Husted needle was inserted using the loss-of resistance (LOR) by air technique. Immediately the patient complained of headaches and then deteriorated to a tonic-clonic movement accompanied by post-seizure sleep, which ended up in termination of the procedure. The first-day CT-scan revealed multiple pneumocephalus. Supporting treatment was administered for 10 days; another CT-scan taken from the patient demonstrated improvement and the patient was discharged without any neurological deficit. Regional analgesia should be administered if possible under the superintendence of an expert, however, complications of an epidural catheter, such as accidental dural puncture, can postpone the recovery of the patient.