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Brazilian Journal of Anesthesiology... 2023
Topics: Humans; Pneumocephalus; Postoperative Complications; Tomography, X-Ray Computed
PubMed: 37517586
DOI: 10.1016/j.bjane.2023.07.005 -
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 -
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 -
Pediatric Emergency Care Nov 2023Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head...
OBJECTIVES
Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI.
METHODS
We retrospectively identified pediatric mTBI patients with pneumocephalus using the institutional database of a large regional trauma referral center. Outcome measures were defined as clinically important TBI (ciTBI), hospitalization, intensive care unit (ICU) admission, and neurosurgical intervention. Comparisons were made between pneumocephalus and control (isolated linear fracture) groups as well as between isolated (only linear fracture and pneumocephalus) and nonisolated pneumocephalus (pneumocephalus and TBI) groups.
RESULTS
Among 3524 pediatric mTBI cases, 43 cases had pneumocephalus (1.2%). Twenty-one cases (48.8%) had isolated pneumocephalus. The pneumocephalus group had higher rates of ciTBI, hospital admission, ICU admission, and neurosurgery when compared with the isolated linear fracture (control) group. The isolated pneumocephalus group had fewer ciTBI (21.1% vs 70%, P = 0.002), fewer hospitalization (23.8% vs 81.8%, P < 0.001), but similar ICU admission rates (4.8% vs 22.7%, P = 0.089) and length of hospital stay (4.0 ± 2.7 vs 3.6 ± 2.4 days, P = 0.798) in comparison to the nonisolated pneumocephalus group. None of the patients in the isolated group had neurosurgery whereas 2 patients in the nonisolated pneumocephalus group underwent surgery. Multivariable analysis revealed pneumocephalus as an independent predictor of ciTBI and hospital admission, but not ICU admission or neurosurgical intervention.
CONCLUSION
Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.
Topics: Child; Humans; Brain Concussion; Pneumocephalus; Retrospective Studies; Clinical Relevance; Brain Injuries, Traumatic; Fractures, Bone
PubMed: 37815282
DOI: 10.1097/PEC.0000000000003060 -
European Journal of Case Reports in... 2023A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental...
UNLABELLED
A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental status. There was placement of a ventriculoperitoneal shunt in 1970 complicated by meningitis, leading to removal of the material and ventriculociternostomy as definitive treatment in 2004. About one month previously, she had undergone a laparoscopic cholecystectomy complicated by an intra-abdominal collection. Clinical examination at the emergency department revealed a Glasgow score of 8 (E3 V1 M4). In the emergency department the patient presented a tonic-clonic seizure before a cerebral CT scan was performed showing a massive compressive pneumocephalus, then a second seizure. The patient was finally admitted to the neurosurgery department and underwent surgery.
LEARNING POINTS
Changes in mental status in a patient with a history of chronic hydrocephalus should alert clinicians to a possible complication.This case reflects the delayed diagnosis of a critically ill patient in the emergency department.
PubMed: 38077697
DOI: 10.12890/2023_004160 -
Ear, Nose, & Throat Journal Jul 2023Spontaneous otogenic pneumocephalus (SOP) is a rare condition. We report a case of SOP that may be related to repeated Valsalva maneuvers. A young woman underwent...
Spontaneous otogenic pneumocephalus (SOP) is a rare condition. We report a case of SOP that may be related to repeated Valsalva maneuvers. A young woman underwent repeated Valsalva maneuvers to restore Eustachian tube function and subsequently developed symptoms that included otalgia, headache, and nausea. A temporal bone computed tomography scan was performed and a diagnosis of SOP was made. Subsequent surgical treatment was performed and no recurrence was found during the 1-year follow-up period. The rarity of SOP and its potential for misdiagnosis pose significant challenges in clinical practice. The Valsalva maneuver is 1 of the contributing factors to this phenomenon. Otologists should be familiar with the potential complications of the Valsalva maneuver and use it with greater caution.
PubMed: 37394781
DOI: 10.1177/01455613231183537 -
Encephalitis (Seoul, Korea) Oct 2023Pneumocephalus refers to a pathologic collection of gas within the cranial cavity and is mostly caused by head trauma and neurosurgical procedures. Spontaneous...
Pneumocephalus refers to a pathologic collection of gas within the cranial cavity and is mostly caused by head trauma and neurosurgical procedures. Spontaneous nontraumatic pneumocephalus is a very rare condition. We herein report an unusual case of community-acquired bacterial meningitis with a combination of acute otitis media, Enterobacter cloacae, and nontraumatic pneumocephalus. A 75-year-old woman presented with fever, mental change, and neck stiffness. Brain imaging demonstrated pneumocephalus and fluid collection in the left mastoid air cells. E. cloacae was isolated from both blood and otorrhea cultures, and the patient was successfully treated with intravenous ceftazidime for 3 weeks. Although E. cloacae is a very rare cause of community-acquired bacterial meningitis in adults, it should be considered as a possible pathogen in otogenic meningitis complicated with pneumocephalus.
PubMed: 37743053
DOI: 10.47936/encephalitis.2023.00164 -
Regional Anesthesia and Pain Medicine Feb 2024Postdural puncture headache (PDPH) is a relatively common acute complication that occurs following regional anesthesia and is among the clinical features of secondary...
BACKGROUND
Postdural puncture headache (PDPH) is a relatively common acute complication that occurs following regional anesthesia and is among the clinical features of secondary intracranial hypotension syndrome (IHS).The aim of this study was to document the radiological findings specific to PDPH with brain MRI and to determine whether these findings differed from those described in the third edition of the International Headache Society's International Classification of Headache Disorders (ICHD-3).
METHODS
Thirty patients who were diagnosed with PDPH based on the ICHD-3 clinical criteria were enrolled in the study and signed the informed consent form approved by our hospital ethics committee. Their symptoms were recorded and they underwent brain MRI before and after the administration of a gadolinium-based contrast agent within 48-72 hours after the onset of their orthostatic headache.
RESULTS
All patients with PDPH presented with MRI features of pachymeningeal enhancement. The thickness of the pachymeningeal enhancement varied from 0.6 mm to 4.1 mm, with a mean of 1.6 mm+0.8.No cases of brain sagging were observed. 4 of the 30 patients presented with intracranial subdural fluid collections, 7 presented with pneumocephalus and 7 pituitary gland enlargement.
CONCLUSIONS
The radiological characteristics of IHS and PDPH are most likely the result of compensatory mechanisms in response to decreased cerebrospinal fluid pressure. The acute nature of PDPH probably causes its radiological MRI characteristics to differ from those of IHS, given that no brain sagging could be demonstrated.
PubMed: 38388010
DOI: 10.1136/rapm-2023-105105