Pneumocephalus after ankle surgery: A Case Report

Abstract

Introduction: Pneumocephalus, or air in the cranial cavity, can have various causes. Traumatic brain injury is the most common cause of pneumocephalus, accounting for 75% of all cases, particularly in those with skull base fractures. Spinal trauma-related pneumocephalus is rare but has been reported, and patients with this condition are usually treated conservatively. Tumors, infections, and iatrogenic causes are responsible for the remaining 25% of cases. Proper management and a high index of suspicion are critical when considering pneumocephalus as a possible complication, as it can result in significant morbidity and potentially life-threatening consequences. Accidental puncture of the dura mater is a common cause of pneumocephalus secondary to epidural anesthesia, and air entry into the intrathecal space is another known cause. Case presentation: This is a 64-year-old female patient who underwent elective ankle surgery, the anesthetic technique was epidural-spinal block needle on needle, no complications during procedure. She was discharged from the Traumatology and Orthopedics service the next morning, 24 hours after her hospital discharge, she was brought back, in the emergency area, she was found with psychomotor agitation, disorientation, no auditory hallucinations, paresthesias were denied, no mentation disorder, with a score on the Glasgow Coma Scale of 14:  Eye opening 4 points, Verbal response 4 points, Motor response 6 points. After 48 hours the CT brain scan revealed absortion of pneumocephalus. Clinical discussion: The causes of neumocephalus resulting from epidural or spinal anesthesia procedures are not entirely understood. However, it is believed to occur due to the introduction of air or gas into the subarachnoid or epidural spaces during the puncture, accidental or not . Given the potential severity of this condition, early diagnosis and appropriate management are crucial, even if the symptoms differ from the most common. Conclusion: This research paper highlights the importance of anesthesiologists being aware of the potential risks associated with epidural or spinal block.

Future research could investigate the long-term outcomes of patients who experience pneumocephalus during anesthesia procedures and identify strategies for preventing and managing this complication.