Document Type : Case Report


Emergency Department, Al Ain Hospital, Al Ain, United Arab Emirates


Objective: Epidural anesthesia is one of the famous, generally safe, and most requested
pain relief measures in labor. Nevertheless, it can have some complications though
pneumocephalus and subdural effusion are very rare complications.
Case Presentation: A 32-year-old woman presented with a severe persistent headache
after a vaginal delivery, where epidural anesthesia was used for pain control. Her brain
computerized tomography (CT) scan confirmed pneumocephalus and subdural effusion
as a complication of the procedure.
Conclusion: Although headache can be present in many women post-delivery,
investigations should run in susceptible women with alerting signs.


Main Subjects

1. Silva M, Halpern SH. Epidural analgesia for labor: current techniques. Local Reg Anesth 2010; 3: 143-53. doi: 10.2147/lra.s10237.
2. Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuraxial analgesia
and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth 2004; 13(4): 227-33. doi: 10.1016/j.ijoa.2004.04.008.
3. Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management.  Postgrad Med J 2006; 82(973): 713-6. doi: 10.1136/pgmj.2006.044792.
4. Goldszmidt E, Kern R, Chaput A, Macarthur A. The incidence and etiology of postpartum headaches: a
prospective cohort study. Can J Anaesth 2005; 52(9): 971-7. doi: 10.1007/bf03022061.
5. Álvarez-Holzapfel MJ, Aibar Durán J, Brió Sanagustin S, de Quintana-Schmidt C. (Diffuse pneumocephalus after lumbar stab wound). An Pediatr (Barc) 2019; 90(1): 63-4.doi: 10.1016/j.anpedi.2018.04.012.
6. Pillai P, Sharma R, MacKenzie L, Reilly EF, Beery PR 2nd,Papadimos TJ, et al. Traumatic tension pneumocephalus -Two cases and comprehensive review of literature. Int J Crit Illn Inj Sci 2017; 7(1): 58-64. doi: 10.4103/ijciis.ijciis_8_17.
7. Zasler ND, Katz DI, Zafonte RD. Brain Injury Medicine: Principles and Practice. Demos Medical Publishing; 2007.
8. Karavelioglu E, Eser O, Haktanir A. Pneumocephalus and pneumorrhachis after spinal surgery: case report and review of the literature. Neurol Med Chir (Tokyo) 2014; 54(5): 405-7. doi: 10.2176/nmc.cr2013-0118.
9. Kaye AH. Head injuries. In: Essential Neurosurgery, vol 4. 3rd ed. Hoboken: Blackwell Publishing; 2005. p. 40-55.
10. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth 2003; 50(5): 460-9. doi: 10.1007/bf03021057.
11. Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Int J Obstet Anesth 2008; 17(4): 329-35. doi: 10.1016/j.ijoa.2007.04.009.
12. Lee KS, Bae WK, Park YT, Yun IG. The pathogenesis and fate of traumatic subdural hygroma. Br J Neurosurg 1994; 8(5): 551-8. doi: 10.3109/02688699409002947.
13. Heegaard WG, Biros MH. Head injury. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency
Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014.
14. Pannullo SC, Reich JB, Krol G, Deck MD, Posner JB. MRI changes in intracranial hypotension. Neurology 1993;43(5): 919-26. doi: 10.1212/wnl.43.5.919.