Abstract
Pneumocephalus, the presence of air within the intracranial space, is a rare but recognized complication following epidural procedures. It is more commonly associated with neurosurgical interventions or trauma. We report the case of a 94-year- old female who developed acute pneumocephalus during an epidural steroid injection, presenting with severe dizziness, hypertensive emergency (BP 236/137 mmHg), loss of consciousness, and subsequent spontaneous recovery. Computed tomography (CT) of the head revealed air in the suprasellar region, subarachnoid space, and third ventricle. The patient was treated conservatively with 100 % oxygen and positioning, showing marked improvement on follow-up imaging. This case highlights the importance of early recognition and management of pneumocephalus following epidural procedures, which can manifest with diverse and potentially severe symptoms. Prompt intervention typically results in a favorable prognosis, as seen in our patient, who was discharged without complications. Our case adds to the spectrum of clinical presentations by illustrating the uncommon combination of hypertensive crisis and acute pneumocephalus during an epidural procedure.