Symptomatic pneumocephalus following difficult epidural catheter placement treated with hyperbaric oxygen therapy.

Pneumocephalus following epidural catheter placement is a rare but feared complication. Less than 1% of patients develop symptoms. Depending on the volume and location of air entrained, symptoms range from headaches, to brain herniation, and strokes. The classic treatment involves application of 100% oxygen via non-rebreather masks. In severe cases, ventricular shunt placement and hyperbaric oxygen have been reported. We present a healthy 29-year-old female with a history of obesity (BMI 40) who developed symptomatic pneumocephalus following three difficult attempts at epidural catheter placement using loss of resistance techniques to saline. The patient went on to have an uneventful vaginal delivery. However, two hours postpartum, she developed decreased grip strength in her left hand prompting a rapid response and stroke workup.