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Diagnosis airhead: a case of pneumocephalus in labor

Published:March 05, 2019DOI:https://doi.org/10.1016/j.ajog.2019.02.057
      This noncontrast computer tomography of the head reveals pneumocephalus, caused by air entering the meninges during epidural placement. The 36 year old gravida 7 para 3033 at 40 weeks complained of right-sided swelling around her eyes and cheek shortly after epidural placement. She was noted to have right-sided ptosis and hemianesthesia of the right side of her face. A neurology consult was called because of concern for stroke and the computer tomography was obtained (Figures 1 and 2). The images reveal a focus of air adjacent to the right internal carotid artery, consistent with cranial nerve 3 irritation, leading to the patient’s symptoms. While her initial findings were alarming, 6 hours later they began to improve, and she proceeded to have a normal labor course and a spontaneous vaginal delivery.
      Figure thumbnail gr1
      Figure 1Noncontrast head CT showing areas of pneumocephalus
      Jayakumaran. A case of pneumocephalus in labor. Am J Obstet Gynecol 2019.
      Figure thumbnail gr2
      Figure 2Noncontrast head CT with lung window applied enhancing region of pneumocephalus
      Jayakumaran. A case of pneumocephalus in labor. Am J Obstet Gynecol 2019.
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