• W J Becker.
• University of Calgary and Calgary Health Region, Calgary, Alberta, Canada.
• Can J Neurol Sci. 2002 Aug 1;29(3):278-81.

BackgroundPneumocephalus can be a cause of headache, but is easily overlooked in some clinical circumstances.Case StudyA 35-year-old woman developed severe headache of abrupt onset during an epidural blood patch procedure done for a post-lumbar puncture headache. A brain CT scan showed subarachnoid air even though there was no evidence of a dural puncture having occurred during the procedure.ResultsThe experience of our patient, and a review of the literature suggests that air injected into the epidural space during use of the "loss of resistance" technique can enter the subarachnoid space if a dural puncture site from a previous lumbar puncture is present.ConclusionsPneumocephalus should be considered as a potential cause for a severe headache occurring in association with epidural procedures, and also in a number of other clinical settings. Use of a high inspired air oxygen concentration can hasten absorption of an intracranial air collection.

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