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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 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 -
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 -
SA Journal of Radiology 2023Imaging evaluation of the brain and cranium after cranial surgery is a routine and significant part of the workflow of a radiology department. Various normal expected... (Review)
Review
UNLABELLED
Imaging evaluation of the brain and cranium after cranial surgery is a routine and significant part of the workflow of a radiology department. Various normal expected findings and early and late complications are associated with the post-operative cranium. In this pictorial review, the authors describe the typical imaging features of the spectrum of various conditions associated with cranial surgery with illustrative cases.
CONTRIBUTION
A good knowledge and understanding of the spectrum of imaging appearances in the post-operative cranium is vital for the radiologist to accurately diagnose potential complications and distinguish them from normal post-operative findings, improving patient outcomes and guiding further treatment.
PubMed: 38059119
DOI: 10.4102/sajr.v27i1.2684 -
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 -
World Journal of Critical Care Medicine Dec 2023Pneumorrhachis (PR) is defined as presence of free air in the spinal canal. Traumatic PR is very rare, and its exact incidence and pathogenesis is unknown. A... (Review)
Review
Pneumorrhachis (PR) is defined as presence of free air in the spinal canal. Traumatic PR is very rare, and its exact incidence and pathogenesis is unknown. A comprehensive literature search was performed using the PubMed, Cochrane Library, Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023. A total of 34 resources were selected for inclusion in this narrative review. Traumatic PR can be classified anatomically into epidural and intradural types. In the epidural type, air is present peripherally in the spinal canal and the patients are usually asymptomatic. In contrast, in intradural PR, air is seen centrally in the spinal canal and patients present with neurological symptoms, and it is a marker of severe trauma. It is frequently associated with traumatic pneumocephalus, skull fractures or thoracic spine fracture. Computed tomography (CT) is considered to be the diagnostic modality of choice. Epidural PR is self-limited and patients are generally managed conservatively. Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak, with a need for surgical intervention. Differentiation between epidural and intradural PR is important, because the latter is an indication of severe underlying injury. CT imaging of the entire spine must be performed to look for extension of air, as well as to identify concomitant skull, torso or spinal injuries Most patients are asymptomatic and are managed conservatively, but a few may develop neurological symptoms that need further evaluation and management.
PubMed: 38188452
DOI: 10.5492/wjccm.v12.i5.248 -
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