Cerebellar syndrome after occipital nerve block: A case report

Abstract

Background Occipital nerve blocks are commonly used in the treatment of different types of refractory headaches. The procedure is considered safe, and serious complications have rarely been described. Case presentation We report a serious complication of occipital nerve blockade secondary to the penetration of local anesthetic and non-steroidal anti-inflammatory drugs into the posterior fossa in a patient affected by type I Arnold Chiari malformation. Conclusions This case reminds that a proper injection technique is mandatory to avoid potentially severe complications when performing occipital nerve blocks.

Narrative review of peripheral nerve blocks for the management of headache

“…Though serious adverse events are uncommon, a few case reports underscore the importance of proper injection technique. Five patients have been reported to develop an acute cerebellar syndrome after GON blocks 40,100,101 . One patient with a Chiari malformation and possible excessive anterolateral neck flexion during positioning was reported to have needle penetration and injection of local anesthetic and non‐steroidal anti‐inflammatory drugs into the cerebellar tonsils 100 .…”

“…Five patients have been reported to develop an acute cerebellar syndrome after GON blocks 40,100,101 . One patient with a Chiari malformation and possible excessive anterolateral neck flexion during positioning was reported to have needle penetration and injection of local anesthetic and non‐steroidal anti‐inflammatory drugs into the cerebellar tonsils 100 . The other four were receiving injections at the C2 level and described unilateral dysmetria, dysdiadochokinesia, and ataxic gait for about 4–6 h after their procedure 40,101 .…”

“…40,100,101 One patient with a Chiari malformation and possible excessive anterolateral neck flexion during positioning was reported to have needle penetration and injection of local anesthetic and non-steroidal anti-inflammatory drugs into the cerebellar tonsils. 100 The other four were receiving injections at the C2 level and described unilateral dysmetria, dysdiadochokinesia, and ataxic gait for about 4-6 h after their procedure. 40,101 Skull base abnormalities, such as a previous posterior fossa craniotomy, have been associated with post-injection loss of consciousness 102 and coma, 103 and are considered a contraindication for landmark-based occipital nerve blocks.…”