Pneumocephalus After Spinal — FRCA Final MCQ

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HardRegional AnaesthesiaPneumocephalus After SpinalFRCA Final

A 35-year-old woman (ASA I) is having minor gynaecological surgery. She receives spinal anaesthesia. Twenty minutes later she develops a severe headache while still on the operating table. This is NOT a post-dural puncture headache. What is the most likely cause?

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Correct answer: A — Pneumocephalus from air injection during the spinal

A headache occurring during or immediately after spinal anaesthesia (while still supine/recumbent) is NOT a PDPH (which is characteristically postural – worse upright, better lying down). The most likely cause is pneumocephalus from inadvertent injection of air during the spinal procedure. Air can enter the subarachnoid space if the syringe contains an air bubble or if the loss-of-resistance to air technique was used and air tracked intrathecally. The headache is positional (worse sitting up as air rises) and resolves spontaneously as the air is absorbed. Prevention: use saline for loss-of-resistance and ensure no air bubbles in the spinal syringe.

Reference: RCOA – 2023 – Regional anaesthesia complications; Aida S – 1996 – Pneumocephalus after spinal