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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 -
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 -
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 -
The Journal of the Association of... Feb 2021
Topics: Humans; Pneumocephalus; Tomography, X-Ray Computed
PubMed: 33527816
DOI: No ID Found -
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 -
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 Neuroscience Nursing :... Oct 2005Pneumocephalus, air in the cranial cavity, is a common occurrence following cranial surgery. However, tension pneumocephalus, accumulation of air trapped in the cranial... (Review)
Review
Pneumocephalus, air in the cranial cavity, is a common occurrence following cranial surgery. However, tension pneumocephalus, accumulation of air trapped in the cranial cavity causing a mass effect and abnormal neurological signs, is uncommon. Knowledge about conditions that contribute to tension pneumocephalus, a potentially fatal complication, including the related signs and symptoms, is imperative. Immediate collaboration with a physician allows for timely treatment and patient recovery. Treatment measures include preoperative teaching, immediate removal of intracranial air, supine positioning, administration of 100% oxygen, repair of the bony and dural defect, and, if indicated drain placement into the air cavity, temporary tracheotomy, and antibiotics.
Topics: Education, Nursing, Continuing; Humans; Male; Middle Aged; Pneumocephalus; Specialties, Nursing
PubMed: 16379134
DOI: 10.1097/01376517-200510000-00007 -
Surgical Neurology Apr 1995Pneumocephalus is a well-known phenomenon in which a fistula between the thoracic cavity and the subarachnoid space is one of its rare etiologies. (Review)
Review
BACKGROUND
Pneumocephalus is a well-known phenomenon in which a fistula between the thoracic cavity and the subarachnoid space is one of its rare etiologies.
METHODS
We report a new case of pneumocephalus after thoracotomy and review eight similar cases in the literature.
RESULTS
In all cases, an operation was carried out for an intrathoracic neoplasm located at the apex with chest wall invasion. In the presence of symptoms, the diagnosis of pneumocephalus and identification of the subarachnoid pleural fistula were differently supplied by radiographic and isotopic exams. In the follow-up, one patient was affected by meningitis and two patients died.
CONCLUSIONS
The occurrence of pneumocephalus must be considered when neurologic problems emerge after thoracotomy. It appears that if conservative treatment fails, surgical closure of the fistula via thoracic or neurosurgical approach is indicated.
Topics: Aged; Humans; Male; Pneumocephalus; Thoracotomy
PubMed: 7792714
DOI: 10.1016/0090-3019(95)80072-o