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The Journal of Craniofacial Surgery May 2021This paper presents a case of tension pneumocephalus with severe headache 2 days after septoplasty surgery. In such cases, endoscopic sinus surgery (ESS) or open...
This paper presents a case of tension pneumocephalus with severe headache 2 days after septoplasty surgery. In such cases, endoscopic sinus surgery (ESS) or open approach can be used for repair of the defect. However, pneumocephalus, especially caused by minor defects, improves spontaneously with conservative treatment. In our case, the pneumocephalus was responsive to conservative treatment with bed rest, head elevation. His examinations in the 3rd and 8th months after discharge were uneventful and CT scan revealed no signs of pneumocephalus. In severe headaches developing after septoplasty, the possibility of intracranial complications should be evaluated. Simple conservative treatment should be tried before surgery, but then the patient should be examined at regular intervals.
Topics: Endoscopy; Humans; Pneumocephalus; Postoperative Complications; Rhinoplasty; Tomography, X-Ray Computed
PubMed: 33534302
DOI: 10.1097/SCS.0000000000007186 -
The Journal of Emergency Medicine Dec 2020Traumatic tension pneumocephalus is a rare complication after craniofacial fractures that can cause devastating neurologic deficits if not managed promptly and...
BACKGROUND
Traumatic tension pneumocephalus is a rare complication after craniofacial fractures that can cause devastating neurologic deficits if not managed promptly and effectively.
CASE REPORT
A 38-year-old man with no past medical history presented to the Emergency Department (ED) after a motor vehicle crash. He was noted to have an open frontal scalp laceration. Computed tomography (CT) revealed a right frontal subdural hematoma and right medial frontal contusion. There was also a frontal bone fracture extending through the frontal sinus with mild underlying pneumocephalus. He was monitored for cerebrospinal fluid (CSF) leak and was subsequently discharged on postinjury day 9. He re-presented to the ED 14 days post injury with lethargy, confusion, headache, and swelling around his scalp laceration. A CT scan was obtained that revealed a large-volume intraparenchymal pneumocephalus (pneumocerebri) with mass effect and midline shift. The patient was started on 100% oxygen and admitted to the intensive care unit. He was taken to the operating room for evacuation of the pneumocerebri, repair of dural defect, placement of a vascularized pericranial graft, and placement of a lumbar drain. His lumbar drain was removed on postoperative day 3 and he was discharged home neurologically intact on postoperative day 6. At 1 month follow-up he had no evidence of CSF leak and was neurologically intact. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case is presented to increase awareness among emergency physicians that traumatic tension pneumocephalus, and in this case, pneumocerebri, is a rare life-threatening neurosurgical emergency in patients with severe craniofacial fractures after blunt or penetrating head trauma. Early temporizing measures in the ED, such as 100% oxygen via nonrebreather face mask, and urgent neurosurgical consultation are indicated to prevent neurologic deterioration.
Topics: Adult; Cerebrospinal Fluid Leak; Craniocerebral Trauma; Frontal Sinus; Humans; Male; Pneumocephalus; Skull Fractures
PubMed: 32917449
DOI: 10.1016/j.jemermed.2020.08.001 -
Case Reports in Radiology 2019Pneumocephalus in the absence of trauma, tumour, or surgery is a rare entity. We report a case of a 73-year-old lady who presented with sepsis leading to confusion and...
Pneumocephalus in the absence of trauma, tumour, or surgery is a rare entity. We report a case of a 73-year-old lady who presented with sepsis leading to confusion and unresponsiveness. A CT of brain revealed mastoiditis, sinusitis, and associated pneumocephalus. Further investigations led to an eventual diagnosis of pneumococcal meningitis. The combination of pneumocephalus and meningitis as complications of mastoiditis is rare with very few cases published in the literature. We describe one such case.
PubMed: 30915252
DOI: 10.1155/2019/7876494 -
International Journal of Surgery Case... 2017Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly.
INTRODUCTION
Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly.
CASE PRESENTATION
We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43- year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury.
CONCLUSIONS
These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.
PubMed: 28152490
DOI: 10.1016/j.ijscr.2017.01.038 -
Medicina 2016
Topics: Adult; Head Injuries, Penetrating; Humans; Male; Pneumocephalus; Tomography, X-Ray Computed; Trauma Severity Indices
PubMed: 27295712
DOI: No ID Found -
Neurosurgical Review Jan 2024Pneumocephalus is the pathologic collection of air in the intracranial cavity. In sufficient volumes, it can contribute to symptoms ranging from headaches to death. For... (Review)
Review
Pneumocephalus is the pathologic collection of air in the intracranial cavity. In sufficient volumes, it can contribute to symptoms ranging from headaches to death. For conservative treatment, oxygen use is commonplace. Although this is an accepted tenet of clinical practice, it is not necessarily founded on robust trials. An electronic search of databases EMBASE and MEDLINE and the Cochrane Library was undertaken as per the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. Three articles were included. Although the modes of oxygen delivery were heterogenous (non-rebreather versus endotracheal versus hyperbaric chamber), all studies concluded favorably on the use of oxygen therapy for increased reabsorption of pneumocephalus.
Topics: Humans; Pneumocephalus; Headache; Oxygen
PubMed: 38172487
DOI: 10.1007/s10143-023-02261-4 -
British Journal of Neurosurgery Oct 2023Bariatric surgery is an effective treatment for patients with idiopathic intracranial hypertension (IIH), a condition that is associated with skull base defects. A...
Bariatric surgery is an effective treatment for patients with idiopathic intracranial hypertension (IIH), a condition that is associated with skull base defects. A 55-year-old woman presented with symptoms of intractable nausea and vomiting, followed by headache and confusion two weeks after an elective laparoscopic vertical sleeve gastrectomy procedure. She had a presumed diagnosis of IIH and a remote history of CSF oto/rhinorrhea treated with a lumbar peritoneal (LP) shunt. Computed tomography (CT) scan of the head revealed tension pneumocephalus with midline shift and dehiscence of the tegmen. The patient underwent emergent craniotomy for decompression of the air-filled temporal lobe, clamping of the LP shunt, and repair of the skull base defect. Caution should be exercised in obese patients with a history of CSF leak secondary to a middle fossa skull base defect when being evaluated for bariatric surgery.
Topics: Female; Humans; Middle Aged; Pneumocephalus; Cerebrospinal Fluid Rhinorrhea; Tomography, X-Ray Computed; Treatment Outcome; Bariatric Surgery; Pseudotumor Cerebri
PubMed: 33393846
DOI: 10.1080/02688697.2020.1866166 -
Neuromodulation : Journal of the... Dec 2023This research analyzed the effect of surgical positioning on postoperative pneumocephalus and assessed additional potential risk factors of pneumocephalus in subthalamic...
OBJECTIVES
This research analyzed the effect of surgical positioning on postoperative pneumocephalus and assessed additional potential risk factors of pneumocephalus in subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD).
MATERIALS AND METHODS
In this study, 255 consecutive patients with PD who received bilateral STN DBS under general anesthesia were retrospectively included. Of these, 180 patients underwent surgery with their heads in an elevated position, and 75 patients underwent surgery in a supine position. The postoperative pneumocephalus volume was compared between the two groups. Other potential risk factors for pneumocephalus also were analyzed.
RESULTS
The mean pneumocephalus volume for the group with elevated-head positioning (16.76 ± 15.23 cm) was greater than for the supine group (3.25 ± 8.78 cm) (p < 0.001). Multivariable analysis indicated that the pneumocephalus volume was related to surgical positioning, lateral trajectory angle, intraoperative mean arterial pressure (MAP), microelectrode recording (MER) passage number, brain atrophy degree, and the anterior trajectory angle. No correlation was found between pneumocephalus and age, sex, duration of PD, surgery length, or intracranial volume. In the subgroup analysis, the pneumocephalus volume exhibited a negative correlation with intraoperative MAP (r = -0.210, p = 0.005) and positive correlations with degree of brain atrophy (r = 0.242, p = 0.001) and MER passage number (r = 0.184, p = 0.014) in the elevated-head group. Specifically, an MER passage number > 3 was a significant risk factor for pneumocephalus in the elevated-head group. A positive correlation was observed between the pneumocephalus volume and the lateral trajectory angle in both groups (elevated-head positioning, r = 0.153, p = 0.041; supine positioning, r = 0.546, p < 0.001).
CONCLUSIONS
In patients with PD who were anesthetized and receiving STN DBS, supine positioning reduced pneumocephalus volume compared with patients with PD receiving STN DBS with their heads elevated. The pneumocephalus volume was negatively correlated with intraoperative MAP and positively correlated with the degree of brain atrophy, the lateral trajectory angle, and the MER passage number.
Topics: Humans; Parkinson Disease; Subthalamic Nucleus; Retrospective Studies; Deep Brain Stimulation; Pneumocephalus; Microelectrodes; Atrophy
PubMed: 36272897
DOI: 10.1016/j.neurom.2022.09.003 -
The Journal of Emergency Medicine Dec 2023Pneumocephalus is defined as gas in the intracranial space. Common causes include head trauma, surgery, and diagnostic/therapeutic procedures resulting from the direct... (Review)
Review
BACKGROUND
Pneumocephalus is defined as gas in the intracranial space. Common causes include head trauma, surgery, and diagnostic/therapeutic procedures resulting from the direct disruption of the dura. Spontaneous or nontraumatic pneumocephalus is an uncommon condition, often caused by infection, either due to insidious disruption of the dura or gas-forming pathogens.
CASE REPORT
Herein, we report a rare case of spontaneous pneumocephalus associated with meningitis in a patient who received conservative treatment without surgical intervention. Blood culture revealed group A streptococcus. The pneumocephalus subsided gradually with antibiotic treatment, and no neurological deficits remained. A follow-up brain computed tomography scan showed the absence of pneumocephalus, but it showed progressive hydrocephalus. The patient was discharged on the 21st day of hospitalization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous pneumocephalus associated with meningitis is rare. It should always raise the suspicion of meningitis and prompt suitable treatment. Emergency physicians should always be vigilant for this particular possibility on brain computed tomography.
Topics: Humans; Pneumocephalus; Meningitis; Neuroimaging
PubMed: 37838493
DOI: 10.1016/j.jemermed.2023.06.013 -
Ophthalmology Dec 2023
Topics: Humans; Mediastinal Emphysema; Pneumocephalus; Compressed Air; Conjunctiva
PubMed: 36682976
DOI: 10.1016/j.ophtha.2022.12.023