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Rhode Island Medical Journal (2013) Jun 2021Tension pneumocephalus (TPC) is a rare but devastating intracranial condition where increased intracranial pressure due to entrapped air causes compression of the brain... (Review)
Review
Tension pneumocephalus (TPC) is a rare but devastating intracranial condition where increased intracranial pressure due to entrapped air causes compression of the brain leading to headache, seizures, altered mental status (AMS), and death. The author presents the case of patient with a past medical history of eye-enucleation who subsequently developed TPC in the setting of occult trauma. The diagnosis was made via commuted tomography (CT) scan and the patient underwent needle and burr-hole decompression in the emergency department (ED). TPC is a rare cause of altered mental status, which occurs most often secondary to trauma, and should be considered in patients with AMS and trauma.
Topics: Brain; Headache; Humans; Pneumocephalus; Seizures; Tomography, X-Ray Computed
PubMed: 34044439
DOI: No ID Found -
Brazilian Journal of Anesthesiology... 2023
Topics: Humans; Pneumocephalus; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 37517586
DOI: 10.1016/j.bjane.2023.07.005 -
Journal of Neurosurgical Anesthesiology Apr 2023
Topics: Humans; Pneumocephalus; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 35051974
DOI: 10.1097/ANA.0000000000000832 -
Journal of the Belgian Society of... 2022Spontaneous, atraumatic pneumocephalus is a rare presentation of pneumococcal meningitis.
Spontaneous, atraumatic pneumocephalus is a rare presentation of pneumococcal meningitis.
PubMed: 36618029
DOI: 10.5334/jbsr.2993 -
Neurocritical Care Apr 2016Spontaneous pneumocephalus in the nontraumatic setting is distinctly unusual. Pneumocephalus from central nervous system infection with Clostridium septicum has been...
BACKGROUND
Spontaneous pneumocephalus in the nontraumatic setting is distinctly unusual. Pneumocephalus from central nervous system infection with Clostridium septicum has been rarely reported, and more commonly reflects a later stage of abscess formation. We present an unusual case of invasive C. septicum infection without an associated diagnosed malignancy presenting with rapidly progressive CNS pathology and resultant early pneumocephalus.
METHODS
Medical records, radiologic imaging, and microbiological specimens of a case were reviewed.
RESULTS
A 66-year-old male presented with a history of two witnessed generalized tonic-clonic seizures on awakening. He was found unresponsive at the scene by paramedics and subsequently intubated. There was no reported antecedent symptomatology, such as headache, fever, chills, focal weakness, and speech or gait disturbances. Medical history was remarkable only for diet-controlled hypertension. Computed tomography (CT) head imaging revealed an abnormal right parietal hypodensity. The patient was evaluated per the acute stroke protocol but was not deemed a candidate for intervention or thrombolytic therapy given the uncertainty of his clinical presentation; intravenous antibiotics were administered for possible sepsis. Follow-up CT imaging of the head performed 8 h later revealed right parieto-temporal pneumocephalus with extensive cerebral edema and effacement of basilar cisterns. Neurosurgical intervention was not deemed appropriate given the catastrophic nature of his injury and the patient subsequently expired 14 h after presentation. Blood cultures grew gram-positive rods in three of four bottles identified as C. septicum.
CONCLUSIONS
Clostridium septicum is an uncommon and often fatal cause of nontraumatic pneumocephalus. This underscores the need for a high index of clinical suspicion in cases with unexplained pneumocephalus, as early diagnosis remains the key to survival. In survivors of C. septicum infection, subsequent colonoscopy should be considered to exclude undiagnosed or occult gastrointestinal malignancy.
Topics: Aged; Clostridium Infections; Clostridium septicum; Humans; Male; Pneumocephalus
PubMed: 26399246
DOI: 10.1007/s12028-015-0192-z -
Neurosurgical Review Dec 2022We conducted a meta-analysis to analyze the effects of pneumocephalus after chronic subdural hematoma (CSDH) surgery on hematoma recurrence, mortality, and functional... (Meta-Analysis)
Meta-Analysis Review
We conducted a meta-analysis to analyze the effects of pneumocephalus after chronic subdural hematoma (CSDH) surgery on hematoma recurrence, mortality, and functional outcomes. In this meta-analysis, following PRISMA guidelines, PubMed, Embase, Cochrane Library, and Web of Science online databases were queried using the keywords "pneumocephalus," "pneumoencephalos," "intracranial pneumatocele," "pneumo encephalon," "subdural air," and "chronic subdural hematoma." The results were limited to English-language articles. Through the online database, we identified a total of 276 articles and finally included 14 articles for meta-analysis. The results showed that the recurrence rate in the pneumocephalus group was higher than that in the control group, with a pooled OR of 3.35 (CI: 2.51-4.46, P < 0.001). There was no difference in recurrence rate between the no/few and moderate pneumocephalus groups (OR: 1.27, CI: 0.68-2.37, P = 0.46), but the recurrence rate of the large pneumocephalus group was significantly higher than that of the moderate group, with a pooled OR of 3.29 (CI: 1.71-6.32, P < 0.001). This study failed to show higher mortality and worse outcomes in the pneumocephalus group than in the control. Pneumocephalus after surgical evacuation of CSDH was associated with the recurrence rate of hematoma. Pneumocephalus affecting recurrence was correlated with gas volume, and moderate pneumocephalus may have less impact, while patients with large pneumocephalus are more likely to recur than those with moderate pneumocephalus. More prospective cohort studies are needed for further investigation and verification. This meta-analysis was registered (PROSPERO CRD42022321800).
Topics: Humans; Hematoma, Subdural, Chronic; Prospective Studies
PubMed: 36481957
DOI: 10.1007/s10143-022-01925-x -
Anesthesiology Oct 2017
Review
Topics: Biopsy, Fine-Needle; Craniotomy; Humans; Pneumocephalus; Postoperative Complications; Tomography, X-Ray Computed; Ventriculostomy
PubMed: 28537932
DOI: 10.1097/ALN.0000000000001703 -
Acta Neurochirurgica Sep 2022Concerns arise when patients with pneumocephalus engage in air travel. How hypobaric cabin pressure affects intracranial air is largely unclear. A widespread concern is... (Review)
Review
INTRODUCTION
Concerns arise when patients with pneumocephalus engage in air travel. How hypobaric cabin pressure affects intracranial air is largely unclear. A widespread concern is that the intracranial volume could relevantly expand during flight and lead to elevated intracranial pressure. The aim of this systematic review was to identify and summarise models and case reports with confirmed pre-flight pneumocephalus.
METHODS
The terms (pneumocephalus OR intracranial air) AND (flying OR fly OR travel OR air transport OR aircraft) were used to search the database PubMed on 30 November 2021. This search returned 144 results. To be included, a paper needed to fulfil each of the following criteria: (i) peer-reviewed publication of case reports, surveys, simulations or laboratory experiments that focussed on air travel with pre-existing pneumocephalus; (ii) available in full text.
RESULTS
Thirteen studies met the inclusion criteria after title or abstract screening. We additionally identified five more articles when reviewing the references. A notion that repeatedly surfaced is that any air contained within the neurocranium increases in volume at higher altitude, much like any extracranial gas, potentially resulting in tension pneumocephalus or increased intracranial pressure.
DISCUSSION
Relatively conservative thresholds for patients flying with pneumocephalus are suggested based on models where the intracranial air equilibrates with cabin pressure, although intracranial air in a confined space would be surrounded by the intracranial pressure. There is a discrepancy between the models and case presentations in that we found no reports of permanent or transient decompensation secondary to a pre-existing pneumocephalus during air travel. Nevertheless, the quality of examination varies and clinicians might tend to refrain from reporting adverse events. We identified a persistent extracranial to intracranial fistulous process in multiple cases with newly diagnosed pneumocephalus after flight. Finally, we summarised management principles to avoid complications from pneumocephalus during air travel and argue that a patient-specific understanding of the pathophysiology and time course of the pneumocephalus are potentially more important than its volume.
Topics: Air Travel; Humans; Intracranial Hypertension; Intracranial Pressure; Pneumocephalus
PubMed: 35794427
DOI: 10.1007/s00701-022-05297-5 -
The Journal of the Association of... Feb 2021
Topics: Humans; Pneumocephalus; Tomography, X-Ray Computed
PubMed: 33527816
DOI: No ID Found