A44-YR-OLD woman developed a sudden onset severe headache while undergoing a technically challenging epidural insertion before colectomy for ulcerative colitis. No obvious cerebrospinal fluid was noted in the needle and the needle was withdrawn. Given the severity, sudden onset, and persistent nature of the headache, an urgent noncontrast computed tomography scan of the brain was obtained to outrule a subarachnoid hemorrhage as a potential cause. The computed tomography brain demonstrated low attenuation material consistent with extra axial (arrowhead) and subarachnoid air (arrow). There was no evidence of intracranial hemorrhage. The patient's headache resolved within 24 h, and a repeat computed tomography at 48 h was normal.
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