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World Neurosurgery Jan 2018A 53-year-old man was admitted to our hospital following a traffic accident. He had been riding a bicycle and was knocked down by a motorcycle, injuring the right side...
A 53-year-old man was admitted to our hospital following a traffic accident. He had been riding a bicycle and was knocked down by a motorcycle, injuring the right side of his forehead. Upon arrival at our department, he was conscious and we found no cerebrospinal fluid rhinorrhea or otorrhea. His Glasgow Coma Scale score was 15. Neurologic examination was normal, except for reduced vision in his right eye. Head computed tomography showed extensive pneumocephalus involving the cisterna ambiens, prepontine and suprasellar cisterns, and temporal, frontal, parietal, and occipital lobes. A right frontal skull fracture was evident. The patient was treated conservatively, with bed rest with the head of the bed elevated at 30 degrees. The patient was instructed to avoid any movements that might increase intracranial pressure, and he was placed on conventional concentration oxygen therapy of about 40%. Repeat computed tomography 9 hours later showed partial absorption of the pneumocephalus, which was almost completely absorbed 4 days later. He recovered well and was discharged after 7 days. At the 1-month follow-up, the patient was well, although the reduced vision in his right eye persisted.
Topics: Accidents, Traffic; Bed Rest; Humans; Male; Neurologic Examination; Oxygen; Pneumocephalus; Skull Fractures; Treatment Outcome
PubMed: 28974412
DOI: 10.1016/j.wneu.2017.09.151 -
Emergency Radiology Aug 2018Intracranial gas is commonly detected on neuroimaging. The recognition of this finding can at first blush be unsettling. Being able to localize this gas to a specific... (Review)
Review
Intracranial gas is commonly detected on neuroimaging. The recognition of this finding can at first blush be unsettling. Being able to localize this gas to a specific compartment: intraarterial, intravenous, intraparenchymal, subdural, epidural, subarachnoid and intraventricular, is the first step in determining the importance of the gas. Determination of the route of entry: through the skull, extension from a paranasal sinus or the mastoid air cells, via the spine, or trans-vascular, is the other important factor in determining potential consequences. Understanding these parameters allows for a confident determination of etiology. More importantly, it generally provides guidance as to what must be done: either to disregard (e.g., subarachnoid gas following lumbar puncture and intravenous gas following IV placement), obtain follow-up (e.g., postoperative gas), or administer emergent treatment (e.g., intraarterial gas and epidural abscess). In this review, we use gas location and route of entry to classify the various causes of pneumocephalus and provide examples of each of these etiologies.
Topics: Diagnosis, Differential; Humans; Neuroimaging; Pneumocephalus
PubMed: 29546674
DOI: 10.1007/s10140-018-1595-x -
The Journal of Craniofacial Surgery May 2017Pneumocephalus without a known underlying cause is defined as spontaneous pneumocephalus. Few patients of intraventricular pneumocephalus have been reported.
BACKGROUD
Pneumocephalus without a known underlying cause is defined as spontaneous pneumocephalus. Few patients of intraventricular pneumocephalus have been reported.
PATIENT PRESENTATION
An 84-year-old man presented with dysarthria and incontinence. Computed tomography revealed an intraventricular pneumocephalus, thinning in the petrous bone, fluid in the air cells, and cleft in temporal lobe. A right subtemporal extradural approach was taken to detect bone-/-dural defects, and a reconstruction was performed using a musculo-pericranial flap.
CONCLUSION
This is the first patient of an isolated intraventricular spontaneous pneumocephalus without any other site air involved. Surgical approaches to repair such bone and dura defects should be considered an appropriate option.
Topics: Aged, 80 and over; Dura Mater; Humans; Male; Patient Selection; Petrous Bone; Pneumocephalus; Plastic Surgery Procedures; Surgical Flaps; Temporal Lobe; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28085764
DOI: 10.1097/SCS.0000000000003392 -
Journal of Neurological Surgery. Part... Nov 2020Tension pneumocephalus is a treatable emergency that is usually caused by trauma or surgery. We present a rare case of spontaneous tension pneumocephalus. A 64-year-old...
Tension pneumocephalus is a treatable emergency that is usually caused by trauma or surgery. We present a rare case of spontaneous tension pneumocephalus. A 64-year-old woman presented with a severe aggravating headache. Computed tomography revealed a large air collection in the brain parenchyma of the right frontal lobe, both lateral ventricles, and the subarachnoid space. Emergent craniotomy was performed because her headache got progressively worse. We found that an abnormal bony protrusion connected the frontal sinus mucosa and the intraparenchymal pneumocephalus. After removal of the bony mass and repair of the defect, the patient immediately recovered and there was no recurrence.
Topics: Brain; Craniotomy; Female; Frontal Lobe; Frontal Sinus; Headache; Humans; Middle Aged; Neurosurgical Procedures; Pneumocephalus; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32911547
DOI: 10.1055/s-0040-1713798 -
Asian Journal of Neurosurgery 2016Pneumocephalus is commonly seen after head and facial trauma, ear infections, and tumors of the skull base or neurosurgical interventions. In tension pneumocephalus, the... (Review)
Review
Pneumocephalus is commonly seen after head and facial trauma, ear infections, and tumors of the skull base or neurosurgical interventions. In tension pneumocephalus, the continuous accumulation of intracranial air is thought to be caused by a "ball valve" mechanism. In turn, this may lead to a mass effect on the brain, with subsequent neurological deterioration and signs of herniation. Tension pneumocephalus is considered a life-threatening, neurosurgical emergency burr-hole evacuation was performed and he experienced a full recovery. However, more invasive surgery was needed to resolve the condition. Delayed tension pneumocephalus is extremely rare and considered a neurosurgical emergency. Pneumocephalus is a complication of head injury in 3.9-9.7% of the cases. The accumulation of intracranial air can be acute (<72 h) or delayed (≥72 h). When intracranial air causes intracranial hypertension and has a mass effect with neurological deterioration, it is called tension pneumocephalus. We represent a clinical case of a 30-year-old male patient with involved in a road traffic accident, complicated by tension pneumocephalus and cerebrospinal fluid rhinorrhea on 1 month after trauma and underwent urgent surgical intervention. Burr-hole placement in the right frontal region, evacuation of tension pneumocephalus. Tension pneumocephalus is a life-threatening neurosurgical emergency case, which needs to undergo immediate surgical intervention.
PubMed: 27695534
DOI: 10.4103/1793-5482.180904 -
Neurology Feb 2021
Topics: Brain Neoplasms; Cerebrospinal Fluid Rhinorrhea; Glioma; Humans; Male; Middle Aged; Neurosurgical Procedures; Pneumocephalus; Postoperative Complications; Tinnitus
PubMed: 33109623
DOI: 10.1212/WNL.0000000000011126 -
Acute and Critical Care May 2023Collection of air in the cranial cavity is called pneumocephalus. Although simple pneumocephalus is a benign condition, accompanying increased intracranial pressure can...
Collection of air in the cranial cavity is called pneumocephalus. Although simple pneumocephalus is a benign condition, accompanying increased intracranial pressure can produce a life-threatening condition comparable to tension pneumothorax, which is termed tension pneumocephalus. We report a case of tension pneumocephalus after drainage of a cerebrospinal fluid hygroma. The tension pneumocephalus was treated with decompression craniotomy, but the patient later died due to the complications related to critical care. Traumatic brain injury and neurosurgical intervention are the most common causes of pneumocephalus. Pneumocephalus and tension pneumocephalus are neurosurgical emergencies, and anesthetics and intensive care management like the use of nitrous oxide during anesthesia and positive pressure ventilation have important implications in their development and progress. Clinically, patients can present with various nonspecific neurological manifestations that are indistinguishable from a those of a primary neurological condition. If the diagnosis is questionable, patients should be investigated using computed tomography of the brain. Immediate neurosurgical consultation with decompression is the treatment of choice.
PubMed: 35545242
DOI: 10.4266/acc.2021.01102 -
European Journal of Case Reports in... 2020A 44-year-old woman presented with headache and delirium. Brain tomography indicated pneumocephalus, while blood and cerebrospinal fluid cultures revealed . Despite...
UNLABELLED
A 44-year-old woman presented with headache and delirium. Brain tomography indicated pneumocephalus, while blood and cerebrospinal fluid cultures revealed . Despite antibiotic treatment and admission to the intensive care unit, the patient died 3 days later. Pneumocephalus in association with meningitis is very rare and may be caused by gas produced by microorganisms.
LEARNING POINTS
Non-traumatic pneumocephalus should raise the suspicion of meningitis and prompt suitable treatment.Previous pneumococcal saccharide conjugate vaccine administration does not exclude the possibility of serious pneumococcal infection.
PubMed: 32665931
DOI: 10.12890/2020_001677 -
Acta Medica Portuguesa Dec 2019
Topics: Aged; Cerebrospinal Fluid Leak; Humans; Male; Meningitis, Bacterial; Pneumocephalus; Tomography, X-Ray Computed
PubMed: 31851889
DOI: 10.20344/amp.11591 -
Surgical Neurology International 2022Pneumocephalus is the presence of air in the intracranial cavity secondary to communication with the extracranial compartment. It occurs spontaneously, after trauma, or...
BACKGROUND
Pneumocephalus is the presence of air in the intracranial cavity secondary to communication with the extracranial compartment. It occurs spontaneously, after trauma, or after a cranial surgery.
CASE DESCRIPTION
A 62-year-old female, a known case of diabetes mellitus, presented to our emergency department with a sudden thunderclap headache. She was diagnosed with subarachnoid hemorrhage secondary to ruptured anterior communicating artery aneurysm. Twenty days later, she developed pneumonia and subsequently had a cardiac arrest. She was revived after 26 min of cardiopulmonary resuscitation. She developed pneumothorax requiring a chest tube insertion. After the first trial, she developed a diffuse subcutaneous emphysema, and the chest tube was reinserted. Afterward, she became unresponsive with dilated pupils. A computed tomography (CT) scan of the brain showed a diffuse subcutaneous emphysema reaching up to the face with air around the ventriculoperitoneal shunt distal catheter and extending through the burr hole to the ventricles causing pneumocephalus. There was no evidence of skull base fractures on brain CT. Unfortunately, the patient did not recover and passed away 3 days later.
CONCLUSION
This report describes the presentation and radiological findings of an interesting case of pneumocephalus following iatrogenic diffuse subcutaneous emphysema. It aims to increase the emphasis on early anticipation of such rare complication after subcutaneous emphysema.
PubMed: 35855157
DOI: 10.25259/SNI_994_2021