OCULOMOTOR NERVE PALSY IN THE EMERGENCY DEPARTMENT: A COMPLICATION OF EPIDURAL INJECTION

Background: Epidural injections are routinely used for management of radicular pain and are prevalent nonsurgical interventions for chronic low back pain. Pneumocephalus is a rare complication that may occur as a result of inadvertent dural puncture with an epidural needle. Pneumocephalus-induced cranial nerve deficit is also rare, with only a few reported cases. Case Report: We report a case of a 61-year-old woman with a chief complaint of diplopia after she underwent epidural injection for chronic lumbar pain. Her examination was remarkable for a partial right oculomotor nerve palsy. We obtained a computed tomography brain scan, which revealed pneumocephalus. She was managed conservatively and reported complete symptom resolution after 2 weeks. Why Should an Emergency Physician Be Aware of This?: Pneumocephalus is an uncommon complication of epidural spinal injections. Emergency physicians should include this on the differential for a patient presenting with cranial nerve deficit after this procedure. (C) 2019 Elsevier Inc. All rights reserved.