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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 -
Journal of Neurosurgery. Case Lessons May 2023Pneumorrhachis and pneumocephalus are rare conditions in which air is found within the spinal canal and brain, respectively. It is mostly asymptomatic and can be located...
BACKGROUND
Pneumorrhachis and pneumocephalus are rare conditions in which air is found within the spinal canal and brain, respectively. It is mostly asymptomatic and can be located in the intradural or extradural space. Intradural pneumorrhachis should prompt clinicians to search and treat any underlying injury of the skull, chest, or spinal column.
OBSERVATIONS
A 68-year-old man presented with a history of cardiopulmonary arrest together with pneumorrhachis and pneumocephalus following a recurrent pneumothorax. The patient reported acute headaches with no other neurological symptoms. He was managed conservatively with bed rest for 48 hours following thoracoscopic talcage of his pneumothorax. Follow-up imaging showed regression of the pneumorrhachis, and the patient reported no other neurological symptoms.
LESSONS
Pneumorrhachis is an incidental radiological finding that self-resolves with conservative management. However, it can be a complication resulting from a serious injury. Therefore, close monitoring of neurological symptoms and complete investigations should be performed in patients with pneumorrhachis.
PubMed: 37212417
DOI: 10.3171/CASE23129 -
Indian Journal of Otolaryngology and... Apr 2023Spontaneous or post-traumatic CSF (cerebrospinal-fluid) rhinorrhea occurs when there is a skull-base defect. In our study, we tried endoscopic approach, exclusively as...
Spontaneous or post-traumatic CSF (cerebrospinal-fluid) rhinorrhea occurs when there is a skull-base defect. In our study, we tried endoscopic approach, exclusively as surgical modality. To study feasibility of trans-nasal endoscopic approach for repair of skull-base defects and success rates at each anatomical subsite, with complications. Patients, who underwent endoscopic repair of CSF rhinorrhea between 2016 and 2019 were recruited into study. Details of investigative work-up, aetiology, surgery done, site of leak, number of surgical procedures done, post-operative complications and their management, success rate for each anatomical sub-site, was retrieved retrospectively and analyzed. All patients were initially managed with conservative measures before taking up for surgery. Eighteen-patients (male-11, female-7, mean age-40.3 years) with CSF rhinorrhea {spontaneous-5(27.7%), traumatic-13(62.3%)} were found. Sites of leak were cribriform-plate (CP), fovea-ethmoidalis (FE) and posterior-table of frontal-sinus (FS) in 8(44.4%), 5(27.7%) and 5(27.7%) respectively. Twelve (66.6%) patients had no postoperative complications. No patients with defects in CP had post-operative complication. Two (11.1%) patients with FS defect had meningitis, one (5.5%) patient with FS defect developed pneumocephalus. One (5.5%) patient developed frontal sinusitis at end of 4-months. Two (11.1%) patients, each with defects in FE and FS needed a revision repair on postoperative day 0 and 90-till date, none of the patients have any delayed procedure related complications or recurrences. Endoscopic repair of CSF leaks is the norm of the current day due to its minimally invasive nature. However, endoscopic repair of leaks through the frontal sinus were challenging and was associated with a high rate of complications.
PubMed: 37206806
DOI: 10.1007/s12070-022-03272-1 -
Indian Journal of Otolaryngology and... Apr 2023Tension Pneumocephalus and spontaneous CSF rhinorrhea are very rare associations in clinical practice. We report a case of 65 years old male with clear rhinorrhea,...
Tension Pneumocephalus and spontaneous CSF rhinorrhea are very rare associations in clinical practice. We report a case of 65 years old male with clear rhinorrhea, severe frontal headache, vomiting and lethargy for a week. MR Cisternography and CT Paranasal sinuses showed significant Tension Pneumocephalus with defect in the posterior wall of sphenoid sinus and CSF pooling in the sphenoid sinus. Endoscopic trans-sphenoidal CSF leak repair was done without any delay followed by complete resolution of Tension Pneumocephalus with in 4 post op days. Prompt precise diagnosis and early intervention of Tension Pneumocephalus is vital to avoid neurological complications.
PubMed: 37206754
DOI: 10.1007/s12070-022-03223-w -
Cureus Apr 2023Pneumocephalus as a complication of anterior lumbar spinal surgery is extremely rare. A 53-year-old male patient presented with L4 fracture. Posterior fixation from L3...
Pneumocephalus as a complication of anterior lumbar spinal surgery is extremely rare. A 53-year-old male patient presented with L4 fracture. Posterior fixation from L3 to L5 was conducted one day after the trauma. As the patient's neurological deficit persisted, additional anterior surgery by L4 vertebral body replacement was performed on the 19th day. Both surgeries were completed without obvious intraoperative complications. Two weeks after the anterior lumbar surgery, the patient complained of severe headaches, and computed tomography scan revealed pneumocephalus and massive fluid retention in the abdomen. The symptoms improved with conservative treatment, including bed rest, spinal drainage, intravenous drip infusion, and prophylactic administration of antibiotics. Due to the lack of tamponade effect in the soft tissues, a large amount of cerebrospinal fluid leakage may induce and cause progression of pneumocephalus in anterior dural injury.
PubMed: 37206497
DOI: 10.7759/cureus.37726 -
Brain Sciences Mar 2023Deep brain stimulation (DBS) is an effective surgical treatment for essential tremor (ET), with the ventral intermediate nucleus (Vim) and posterior subthalamic area...
BACKGROUND
Deep brain stimulation (DBS) is an effective surgical treatment for essential tremor (ET), with the ventral intermediate nucleus (Vim) and posterior subthalamic area (PSA) as the most common targets. The stimulation efficacy of ET with Vim-PSA double-target DBS has been reported. Herein, we aim to propose surgical techniques for Vim-PSA double-target DBS surgery.
METHODS
This study enrolled six patients with ET who underwent Vim-PSA double-target electrode implantation from October 2019 to May 2022. The targets were located and adjusted using coordinates and multimodality MRI images. A burr hole was accurately drilled in line with the electrode trajectory under the guidance of a stereotactic frame. Novel approaches were adopted during the electrode implantation process for pneumocephalus reduction, including "arachnoid piamater welding" and "water sealing". Electrophysiological recording was used to identify the implantation sites of the electrodes. A 3D reconstruction model of electrodes and nuclei was established to facilitate programming.
RESULTS
The combination of coordinates and multimodality MRI images for target location and adjustment enabled the alignment of Vim and PSA. Postoperative CT scanning showed that the electrode was precisely implanted. Stereotactic guidance facilitated accurate burr hole drilling. "Arachnoid piamater welding" and "water sealing" were efficient in reducing pneumocephalus. Intraoperative electrophysiological verified the efficacy of Vim-PSA double-target DBS surgery.
CONCLUSIONS
The methods for target location and adjustment, accurate drilling of the burr hole, reduction in pneumocephalus, and intraoperative electrophysiological verification are key issues in DBS surgery targeting both the Vim and PSA. This study may provide technical support for Vim-PSA DBS, especially for surgeons with less experience in functional neurosurgery.
PubMed: 37190531
DOI: 10.3390/brainsci13040566 -
Cureus Apr 2023Intradiploic arachnoid cysts are infrequent but benign lesions of the central nervous system. Etiologically, they can be non-traumatic or post-traumatic in origin. We...
Intradiploic arachnoid cysts are infrequent but benign lesions of the central nervous system. Etiologically, they can be non-traumatic or post-traumatic in origin. We present an unusual case of a post-traumatic intradiploic arachnoid cyst presented with recurrent meningitis episodes. A 68-year-old female patient was admitted to the emergency department with fever and loss of consciousness, with a history of cranial operation due to a gunshot injury to the left occipital bone 45 years ago. On the patient's initial examination, nuchal rigidity was detected; Kernig's and Brudzinski's signs were positive. A lumbar puncture has been performed, and the patient is diagnosed with meningitis. The patient had been admitted to the emergency department with rhinorrhea after a minor blunt head trauma six years ago. As we understood from the patient's medical records, a couple of millimetric non-specified pneumocephalus areas, located next to the sella turcica, were detected on the cranial non-contrast-enhanced CT scan after the minor blunt trauma to the frontal bone. However, there was no sign of any obvious skull base fracture. The patient was hospitalized for five days and discharged on the sixth day without any complaints. After the discharge, the patient was admitted to other hospitals five times in the last five years with fever and anxiety. On all her admissions, the patient was diagnosed with CSF-culture-negative meningitis and treated with different unknown antibiotics. Magnetic resonance imaging (MRI) showed some irregularities and thinning at the inner table of the left occipital bone; there was an enlargement of the diploic distance of the occipital bone on the left side. MR cisternography showed cerebrospinal fluid (CSF) fistulizing areas just below the thickened and irregular part of the occipital bone. CSF fistula was communicated with the left lateral ventricle. The occipital horn of the left lateral ventricle was enlarged. We performed a surgical repair in order to cover the defective areas of the occipital and mastoid bones. The retromastoid approach was used. Pedunculated muscle flaps to cover the defective bony areas are used and secured with fibrin glue. There is no evidence of recurrence during the one-year follow-up period of the patient. We present this unusual case to emphasize that if post-traumatic intradiploic arachnoid cysts remain untreated, severe complications, such as episodes of recurrent meningitis, may occur. Although a few cases of these cysts are reported in the literature, a case of post-traumatic intradiploic arachnoid cyst presenting with recurrent meningitis has not been reported. In patients with recurrent meningitis, when no prominent etiology is found and if there is a trauma to the related bone in the patient's history, post-traumatic intradiploic arachnoid cyst should be included in the differential diagnosis.
PubMed: 37168148
DOI: 10.7759/cureus.37124 -
Turkish Journal of Anaesthesiology and... Apr 2023Non-invasive ventilation application in neurocritical care with risk of pneumocephalus is controversial. Non-invasive ventilation-related increased intrathoracic...
Non-invasive ventilation application in neurocritical care with risk of pneumocephalus is controversial. Non-invasive ventilation-related increased intrathoracic pressure increases intracranial pressure via direct transmission of intrathoracic pressure to the intracranial cavity. In addition, increased thoracic pressure decreases venous return to the heart and increases vena jugularis interna pressure, thereby increasing cerebral blood volume. Pneumocephalus is one of the major concerns after non-invasive ventilation application in head/brain trauma patients. Non-invasive mechanical ventilation may be performed in limited conditions in head trauma/brain surgery with appropriate and close monitoring. High-flow nasal cannula oxygen therapy can provide higher FiO2 as manifested by a larger increase in PaO2/FiO2 ratio and provide the theoretical basis in pneumocephalus because augmenting the PaO2 more effectively would accelerate nitrogen (N2) washout. As a result, non-invasive mechanical ventilation may be performed in limited manner in head trauma/ brain surgery with appropriate and close monitoring.
PubMed: 37140571
DOI: 10.5152/TJAR.2023.21116 -
The Indian Journal of Radiology &... Apr 2023
PubMed: 37123566
DOI: 10.1055/s-0042-1760281