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Case Reports
Oculomotor Nerve Palsy in the Emergency Department: A Complication of Epidural Injection.
- Richard N Wang and Leily Naraghi.
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
- J Emerg Med. 2020 Feb 1; 58 (2): e67-e69.
BackgroundEpidural injections are routinely used for management of radicular pain and are prevalent nonsurgical interventions for chronic low back pain. Pneumocephalus is a rare complication that may occur as a result of inadvertent dural puncture with an epidural needle. Pneumocephalus-induced cranial nerve deficit is also rare, with only a few reported cases.Case ReportWe report a case of a 61-year-old woman with a chief complaint of diplopia after she underwent epidural injection for chronic lumbar pain. Her examination was remarkable for a partial right oculomotor nerve palsy. We obtained a computed tomography brain scan, which revealed pneumocephalus. She was managed conservatively and reported complete symptom resolution after 2 weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pneumocephalus is an uncommon complication of epidural spinal injections. Emergency physicians should include this on the differential for a patient presenting with cranial nerve deficit after this procedure.Copyright © 2019 Elsevier Inc. All rights reserved.
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