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IJID Regions Dec 2023Few cases of disease by have been reported, some in immunocompetent patients but mainly in immunocompromised. The current case report describes a 28-year-old female...
Few cases of disease by have been reported, some in immunocompetent patients but mainly in immunocompromised. The current case report describes a 28-year-old female with an initial diagnosis of pituitary macroadenoma. After the initial surgery, the patient was readmitted due to tension pneumocephalus and cerebrospinal fluid (CSF) fistula. Cultures showed in the CSF and Candida albicans in the urine. The patient died after multiple complications. This is the first case of neuroinfection by in the American continent as reviewed. It was not determined as the main cause of death due to the sudden herniation, however, with active infection derived from the identification in two different samples, for this reason, we consider that it could be useful to take it as a cause of disease and a probable cause when the studies for detection of the most common pathogens have been negative.
PubMed: 38020184
DOI: 10.1016/j.ijregi.2023.10.006 -
Medicine Nov 2023We report on a 45-year-old woman who has a ventriculoperitoneal shunt (VPS), experienced drowsy mental status, with hypesthesia and hemiplegia on the left side. Ten days... (Review)
Review
INTRODUCTION AND PATIENT CONCERNS
We report on a 45-year-old woman who has a ventriculoperitoneal shunt (VPS), experienced drowsy mental status, with hypesthesia and hemiplegia on the left side. Ten days ago she underwent laparoscopic cholecystectomy (LC). Computed tomography revealed tension pneumocephalus, with severe compression on the right side of the brain.
INTERVENTIONS AND DIAGNOSIS
She underwent 2 surgeries, the first surgery was to place a subdural drainage catheter, however, the pneumocephalus relapsed after withdrawing the catheter, and the later surgery was to replace the new VPS.
OUTCOMES
After replacing the VPS, the patient recovers completely after 10 weeks of follow-up.
CONCLUSION
To our knowledge, this is the first report of LC-induced tension pneumocephalus in a patient with VPS. The purpose of this study is to share our experience, with the hypothesized mechanism being the retrograde air through the VPS valve because of high abdominal pressurization. We recommend noting the existence of the VPS when the LC or any abdominal laparoscopy is performed. The VPS should be clamped during any laparoscopic procedure until complete depressurization. Furthermore, all patients with VPS who have neurological deterioration after abdominal laparoscopy should be treated as having the diagnosis of a tension pneumocephalus. These patients need emergency surgery to replace VPS and set the valve for high-pressure, which can result in a quick and complete recovery.
Topics: Female; Humans; Middle Aged; Cholecystectomy, Laparoscopic; Head; Hydrocephalus; Laparoscopy; Pneumocephalus; Ventriculoperitoneal Shunt
PubMed: 37960800
DOI: 10.1097/MD.0000000000035967 -
Magnetic Resonance in Medical Sciences... Nov 2023Postsurgery intracranial air usually diminishes, presumably merging with cerebrospinal fluid (CSF) and venous circulation. Our study presents two transsphenoidal surgery...
Postsurgery intracranial air usually diminishes, presumably merging with cerebrospinal fluid (CSF) and venous circulation. Our study presents two transsphenoidal surgery cases, highlighting potential air absorption by arachnoid granulation (AG)-an underexplored phenomenon. AG has long been deemed pivotal for CSF absorption, but recent perspectives suggest a significant role in waste clearance, neuroinflammation, and neuroimmunity. These cases may stimulate renewed research on the multifaceted role of AG in neurofluid dynamics and potentially elucidate further AG functions.
PubMed: 37952943
DOI: 10.2463/mrms.bc.2023-0122 -
North American Spine Society Journal Dec 2023Traumatic pneumocephalus (TPC) following craniofacial injuries is common, but isolated TPC secondary to pneumorrhachis (PR) is the rare result of upward gas migration...
BACKGROUND
Traumatic pneumocephalus (TPC) following craniofacial injuries is common, but isolated TPC secondary to pneumorrhachis (PR) is the rare result of upward gas migration from the spinal canal. In the absence of craniofacial and grossly unstable spinal fractures, the etiology of TPC in polytrauma can be elusive and an underlying diagnosis of acute spinal cord injury (SCI) can be easily missed. We report the first polytrauma case where TPC was the most reliable early sign of SCI.
CASE DESCRIPTION
A 34-year-old polytrauma female with imaging findings of TPC, which was later found to be secondary to an underlying SCI. As a focused exam could not be performed at admission, the TPC was first attributed to undiagnosed craniofacial injuries. Tertiary survey revealed the patient being paraplegic and MRI workup demonstrated an acute SCI at the T3-T4 level. PR was the most likely cause of TPC in the absence of other craniofacial injuries.
OUTCOME
The patient did not have a meaningful recovery given the extensive hemispheric infarcts, spinal cord injury, and respiratory failure.
CONCLUSIONS
Although uncommon, TPC may be an important radiographic sign suggesting the possibility of an underlying SCI in polytrauma patients. especially when focused neurologic assessment is limited at admission. Polytrauma patients with TPC and PR in the absence of coexisting craniofacial fractures require an urgent spine consultation by the ER physician, with possible early spine MRI workup. We suggest a diagnostic algorithm for the early identification of SCI in polytrauma patients presenting with TPC and propose considering 3 groups which may have different risks for SCI based on their clinical presentation and the presence of PR.
PubMed: 37942311
DOI: 10.1016/j.xnsj.2023.100281 -
Neurology India 2023
Topics: Humans; Pneumocephalus; Brain Injuries, Traumatic; Tomography, X-Ray Computed
PubMed: 37929482
DOI: 10.4103/0028-3886.388070 -
Case Reports in Otolaryngology 2023Eighty percent of cerebrospinal fluid leaks (CSF) occur following trauma and complicate 12 to 13% percent of all basilar skull fractures (Prosser, Vender, and Solares,...
Eighty percent of cerebrospinal fluid leaks (CSF) occur following trauma and complicate 12 to 13% percent of all basilar skull fractures (Prosser, Vender, and Solares, 2011). An endoscopic endonasal approach (EEA) is often the preferred method of repair with greater than 90% success rates (Prosser, Vender, and Solares, 2011). We report a case of a 37-year-old man who presented to our regional level 1 trauma centre with multiple facial injuries. Initial cross-sectional imaging revealed multiple, continuous anterior skull base fractures with associated pneumocephalus. Though initially managed conservatively, the patient represented five days later with unilateral left-sided rhinorrhoea. An endoscopic endonasal repair with a multilayer fat, tensor fascia lata, free mucosal graft, and vascularised local flap reconstruction was undertaken. This case highlights the importance of maintaining a high level of suspicion for delayed CSF leak in traumatic base of skull injury. The EEA enables meticulous dissection and thorough inspection of the skull base, facilitating multilayered repair and reconstruction of defects.
PubMed: 37841560
DOI: 10.1155/2023/6996215 -
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 -
Journal of Neurosurgery. Case Lessons Sep 2023Cranial and spinal cerebrospinal fluid (CSF) leaks are associated with opposite CSF fluid dynamics. The differing pathophysiology between spontaneous cranial and spinal...
BACKGROUND
Cranial and spinal cerebrospinal fluid (CSF) leaks are associated with opposite CSF fluid dynamics. The differing pathophysiology between spontaneous cranial and spinal CSF leaks are, therefore, mutually exclusive in theory.
OBSERVATIONS
A 66-year-old female presented with tension pneumocephalus. The patient underwent computed tomography (CT) scanning, which demonstrated left-sided tension pneumocephalus, with an expanding volume of air directly above a bony defect of the tegmen tympani and mastoideum. The patient underwent a left middle fossa craniotomy for repair of the tegmen CSF leak. In the week after discharge, she developed a recurrence of positional headaches and underwent head CT. Further magnetic resonance imaging of the brain and thoracic spine showed bilateral subdural hematomas and multiple meningeal diverticula.
LESSONS
Cranial CSF leaks are caused by intracranial hypertension and are not associated with subdural hematomas. Clinicians should maintain a high index of suspicion for intracranial hypotension due to spinal CSF leak whenever "otogenic" pneumocephalus is found. Close postoperative follow-up and clinical monitoring for symptoms of intracranial hypotension in any patients who undergo repair of a tegmen defect for otogenic pneumocephalus is recommended.
PubMed: 37728168
DOI: 10.3171/CASE23300 -
Cureus Aug 2023Pneumocephalus, or air entrapment within the cranium, is a rare but dangerous condition with a variety of causes, including trauma, surgery, or predisposing infection....
Pneumocephalus, or air entrapment within the cranium, is a rare but dangerous condition with a variety of causes, including trauma, surgery, or predisposing infection. Trauma is the most common etiology, as fractures provide easy access for air to become entrapped in the cranium. However, access such as via the central nervous system with leak exists. Though not as common as traumatic pneumocephalus, pneumocephalus secondary to infection is a dangerous condition. The literature is sparse on this example of ear-nose-throat infection, making it difficult to form and ascertain guidelines for the management of infectious pneumocephalus and its complications. A 58-year-old man with a history of hypertension, obesity, type 2 diabetes mellitus, and obstructive sleep apnea who presented with a complicated case of acute otitis media associated with subdural empyema, pneumocephalus, and group A Streptococcus is presented in this case report. We describe the course of his hospital stay, management, and current infectious disease guidelines. Given the paucity of cases of infectious pneumocephalus secondary to otitis media, we aim to provide further representation for this important illness as well as encourage the use of a multimodal team of providers. In our case, it was necessary to involve the ear-nose-throat specialist as well as infectious disease and neurocritical care services.
PubMed: 37727174
DOI: 10.7759/cureus.43756 -
Medical Gas Research 2024Nitrous oxide (NO) is a unique anesthetic agent that has both advantages and disadvantages, especially in neurosurgical patients. Various studies evaluating the use of... (Randomized Controlled Trial)
Randomized Controlled Trial
Nitrous oxide (NO) is a unique anesthetic agent that has both advantages and disadvantages, especially in neurosurgical patients. Various studies evaluating the use of NO in different surgical populations have been inconclusive so far. In this prospective, single-blinded, randomized study, 50 patients of either sex, aged 18-60 years, were enrolled and randomly allocated into NO or NO free group. Data including demographics, intraoperative vitals, blood gases, intravenous fluids, anesthetic drug consumption, brain condition, emergence and recovery time, duration of surgery and anesthesia, duration of postoperative ventilation, perioperative complications, condition at discharge, and duration of intensive care unit & hospital stay were recorded. There was no significant difference in intensive care unit or hospital stay between the groups. However, a significant difference in intraoperative heart rate and mean arterial pressure was observed. The incidence of intraoperative tachycardia and hypotension was significantly higher in the NO free group. Other intra- and post-operative parameters, perioperative complications, and conditions at discharge were comparable. Use of NO anesthesia for cerebellopontine tumor surgery in good physical grade and well-optimized patients neither increases the length of intensive care unit or hospital stay nor does it affect the complications and conditions at discharge. However, future studies in poor-grade patients with large tumors and raised intracranial pressure will be required to draw a definitive conclusion.
Topics: Humans; Nitrous Oxide; Sevoflurane; Anesthetics, Inhalation; Prospective Studies; Methyl Ethers; Anesthesia, Inhalation; Neoplasms
PubMed: 37721252
DOI: 10.4103/2045-9912.351105