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Journal of Medical Case Reports May 2023Epidural anesthesia is commonly used for analgesia during labor, and headache is a common complaint following this procedure. Pneumocephalus, on the other hand, is a...
INTRODUCTION
Epidural anesthesia is commonly used for analgesia during labor, and headache is a common complaint following this procedure. Pneumocephalus, on the other hand, is a rare and potentially serious complication of epidural anesthesia, which is most often caused by accidental puncture of the dura with the introduction of air into intrathecal space.
CASE PRESENTATION
We present the case of a 19-year-old Hispanic female who developed a severe frontal headache and neck pain eight hours following epidural catheter placement to deliver analgesia during labor. Physical examination was within normal limits without any neurological deficits. Computed tomography of the head and neck would later demonstrate small to moderate amounts of pneumocephalus, predominantly within the frontal horn of the lateral ventricles, and a moderate amount of air within the spinal canal. She was treated conservatively with analgesia. Though headache recurred after discharge, repeat imaging showed improvement in the volume of pneumocephalus and conservative management was continued.
CONCLUSIONS
Although a rare complication and an uncommon cause of headache following epidural anesthesia, a high index of suspicion must remain for pneumocephalus as it may cause significant morbidity and, in some cases, be potentially life-threatening.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Analgesia, Epidural; Pneumocephalus; Headache; Labor, Obstetric; Pain Management
PubMed: 37231513
DOI: 10.1186/s13256-023-03955-5 -
The Journal of Craniofacial Surgery May 2022Information about the endonasal endoscopic approach (EEA) for the management of posttraumatic tension pneumocephalus (PTTP) remains scarce. Concomitant rhinoliquorrhea... (Review)
Review
OBJECTIVES
Information about the endonasal endoscopic approach (EEA) for the management of posttraumatic tension pneumocephalus (PTTP) remains scarce. Concomitant rhinoliquorrhea and posttraumatic hydrocephalus (PTH) can complicate the clinical course.
METHODS
The authors systematically reviewed pertinent articles published between 1961 and December 2020 and identified 6 patients with PTTP treated by EEA in 5 reports. Additionally, the authors share their institutional experience including a seventh patient, where an EEA resolved a recurrent PTTP without rhinoliquorrhea.
RESULTS
Seven PTTP cases in which EEA was used as part of the treatment regime were included in this review. All cases presented with a defect in the anterior skull base, and 3 of them had concomitant rhinoliquorrhea. A transcranial approach was performed in 6/7 cases before EEA was considered to treat PTTP. In 4/7 cases, the PTTP resolved after the first intent; in 2/ 7 cases a second repair was necessary because of recurrent PTTP, 1 with and 1 without rhinoliquorrhea, and 1/7 case because of recurrent rhinoliquorrhea only. Overall, PTTP treated by EEA resolved with a mean radiological resolution time of 69 days (range 23-150 days), with no late recurrences. Only 1 patient developed a cerebrospinal fluid diversion infection probably related to a first incomplete EEA skull base defects repair. A permanent cerebrospinal fluid diversion was necessary in 3/7 cases.
CONCLUSIONS
Endonasal endoscopic approach repair of air conduits is a safe and efficacious second-line approach after failed transcranial approaches for symptomatic PTTP. However, the strength of recommendation for EEA remains low until further evidence is presented.
Topics: Endoscopy; Humans; Nose; Pneumocephalus; Postoperative Complications; Retrospective Studies; Skull Base
PubMed: 35050560
DOI: 10.1097/SCS.0000000000008204 -
Headache Jul 2019
Topics: Aged; Frontal Sinus; Headache; Humans; Intracranial Hypotension; Magnetic Resonance Imaging; Male; Pneumocephalus; Sneezing
PubMed: 31297808
DOI: 10.1111/head.13590 -
British Journal of Neurosurgery 1991A case of a spontaneous trigemino-pontine pneumocephalus in a 25-year-old man without any known risk factors is described. Other cases of spontaneous pneumocephalus in... (Review)
Review
A case of a spontaneous trigemino-pontine pneumocephalus in a 25-year-old man without any known risk factors is described. Other cases of spontaneous pneumocephalus in the literature are briefly reviewed.
Topics: Adult; Altitude; Cerebellopontine Angle; Humans; Male; Petrous Bone; Pneumocephalus; Radiography; Sneezing; Trigeminal Ganglion; Trigeminal Nerve
PubMed: 1863382
DOI: 10.3109/02688699108998468 -
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 -
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 2020We describe the case of a 65-year-old lady who presented with mutism and a right hemiparesis. Imaging showed a severe spontaneous tension pneumocephalus. The cause was... (Review)
Review
We describe the case of a 65-year-old lady who presented with mutism and a right hemiparesis. Imaging showed a severe spontaneous tension pneumocephalus. The cause was diagnosed as Ecchordosis physaliphora (EP). EP is a rare cystic congenital hamartomatous benign notochordal tumor (BNCT) arising from an ectopic notochordal remnant. To the authors' knowledge, this is the first case of EP to be described in the literature which presented with a life-threatening but treatable condition of severe tension pneumocephalus.
Topics: Aged; Central Nervous System Diseases; Female; Hamartoma; Humans; Notochord; Pneumocephalus
PubMed: 31079493
DOI: 10.1080/02688697.2019.1594695 -
The Lancet. Oncology Sep 2021
Topics: Aged, 80 and over; Anti-Bacterial Agents; Carcinoma, Basal Cell; Humans; Male; Pneumocephalus; Skin Neoplasms; Skull; Treatment Outcome
PubMed: 34478678
DOI: 10.1016/S1470-2045(21)00212-6 -
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 Laryngology and Otology Jul 2012Spontaneous pneumocephalus is a rare condition that has been reported infrequently. Alien limb syndrome is an uncommon phenomenon most often seen in patients with... (Review)
Review
BACKGROUND
Spontaneous pneumocephalus is a rare condition that has been reported infrequently. Alien limb syndrome is an uncommon phenomenon most often seen in patients with frontal and callosal lesions.
METHOD
Case report of a patient with pneumocephalus presenting with alien limb syndrome. The patient underwent successful surgical management. A literature review and discussion of aspects of this presentation are also included.
CONCLUSION
In this case, a spontaneous pneumocephalus has formed a frontal space-occupying lesion and presented with alien limb phenomena.
Topics: Adult; Alien Limb Phenomenon; Bone Diseases; Craniotomy; Ethmoid Bone; Female; Humans; Intracranial Pressure; Magnetic Resonance Imaging; Pneumocephalus; Tomography, X-Ray
PubMed: 22642786
DOI: 10.1017/S002221511200093X