Pneumocephalus After Lumbar Epidural Steroid Injection: A Rare Complication With Spontaneous Resolution

Pneumocephalus is a rare but potentially serious complication of spinal procedures, characterized by the presence of intracranial air. This report presents the case of a 40-year-old female who developed pneumocephalus following a lumbar epidural steroid injection. She presented to the emergency department with a persistent headache, blurred vision, and eye pain, which began shortly after the procedure. Computed tomography (CT) scans of the head and lumbar spine revealed several air pockets in the cerebellar cisterns and the left frontal horn, as well as in the epidural and paraspinal regions. Despite the presence of intracranial air, the patient's symptoms gradually improved with conservative management, including bed rest, caffeinated drinks, intravenous fluids, and symptomatic relief with butalbital-acetaminophen-caffeine. A repeat CT scan on day four showed a reduction in air pockets, and by day 10, all air pockets had resolved without the need for neurosurgical intervention. The patient's headaches subsided, though she experienced mild residual vision changes. This case emphasizes the importance of recognizing pneumocephalus as a potential complication of epidural steroid injections and highlights the efficacy of conservative treatment. While most cases of simple pneumocephalus resolve spontaneously, careful monitoring is essential to prevent progression to tension pneumocephalus, a life-threatening condition that requires urgent surgical intervention. Further studies are needed to evaluate the risks and outcomes of different techniques used during epidural procedures.