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Heliyon Feb 2024Pneumocephalus and empyema in the subarachnoid space secondary to spinal-epidural anesthesia are very rare and have not previously been reported, to our knowledge. Here,...
Pneumocephalus and empyema in the subarachnoid space secondary to spinal-epidural anesthesia are very rare and have not previously been reported, to our knowledge. Here, we describe the imaging features of an older woman presenting with pneumocephalus plus subarachnoid and intraventricular empyema due to Staphylococcus epidermidis infection after spinal-epidural anesthesia, with the aim of raising awareness regarding this serious complication.
PubMed: 38404829
DOI: 10.1016/j.heliyon.2024.e26029 -
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 -
Frontiers in Neurology 2024Traumatic tension pneumocephalus is a rare and life-threatening complication of traumatic brain injury necessitating prompt diagnosis and neurosurgical treatment....
Traumatic tension pneumocephalus is a rare and life-threatening complication of traumatic brain injury necessitating prompt diagnosis and neurosurgical treatment. Nevertheless, various possibilities for impedance in timely management, including patient-related barriers are commonly experienced in low-and middle-income countries setting. Here we presented a delay of management in traumatic tension pneumocephalus case due to initial refusal for emergency surgery. A 59-year-old male presented to the emergency department following a motorcycle accident fully alert with no neurological deficit. He acknowledged clear nasal discharge within 1 h after the initial trauma, but no rhinorrhea or otorrhea was present during physical examination. Head CT revealed extensive pneumocephalus with "Mount Fuji sign," anterior skull base fracture, and frontal sinus fracture. The patient initially refused immediate surgical intervention due to excellent clinical condition and financial scare. Acute decrease of consciousness occurred 40 h post-trauma: GCS of 6 with slight dilatation of both pupils (4 mm) and sluggish pupillary reflex. Emergency bifrontal craniotomy, subdural air drainage, and dura mater tear repair were performed afterwards. Postoperative care was uneventful, with rapid improvement of consciousness and follow-up head CT showing minimal subdural fluid collection and absence of remaining pneumocephalus. The patient was discharged from the hospital after 7 days with GCS of 15 and GOS of 5, proving the importance of overcoming barriers for delay in delivering neurotrauma care in low-and middle-income countries.
PubMed: 38385032
DOI: 10.3389/fneur.2024.1339521 -
Heliyon Feb 2024A 54-year-old female with diabetes was admitted with fever and altered consciousness. Laboratory tests revealed venous blood glucose level of 43.79 mmol/L. Computed...
A 54-year-old female with diabetes was admitted with fever and altered consciousness. Laboratory tests revealed venous blood glucose level of 43.79 mmol/L. Computed tomography (CT) scans of the head, chest, and abdomen showed a right-sided pneumothorax, consolidation, and atelectasis in the right lung; a large heterogeneous density lesion with fluid and gas-fluid levels in the liver; and scattered gas shadows in both kidneys, respectively. Blood and puncture fluid cultures indicated infection with . Based on the susceptibility profiles of the isolates, imipenem was administered intravenously to treat the infection. On the third day of hospitalization, the patient's condition worsened, with head CT showing an extensive cerebral infarction and multiple gas accumulations in the right cerebral hemisphere, as well as a large-area cerebral infarction in the left parietal and occipital lobes. Ultimately, the patient died of multiple organ dysfunction on the fourth day after initial presentation. Although the isolates from the patient showed sensitivity to imipenem, this antibiotic shows poor entry into the central nervous system. The death of the patient indicates that the selection of antibiotics that can cross the blood-brain barrier may be crucial in the outcome of this type of case. Therefore, antibiotics that can penetrate the blood-brain barrier should be selected as soon as possible, and empirical treatment must be initiated immediately after clinical suspicion of invasive , even if the diagnosis has not been determined.
PubMed: 38380024
DOI: 10.1016/j.heliyon.2024.e25745 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Feb 2024
Topics: Humans; Pneumocephalus; Ear, Middle; Tomography, X-Ray Computed
PubMed: 38369796
DOI: 10.3760/cma.j.cn115330-20230816-00048 -
International Journal of Surgery Case... Mar 2024Gas embolism is a rare but fatal clinical emergency. Hydrogen peroxide (HO) can cause gas embolism when improperly used in closed cavities or for deep and large wound...
INTRODUCTION
Gas embolism is a rare but fatal clinical emergency. Hydrogen peroxide (HO) can cause gas embolism when improperly used in closed cavities or for deep and large wound irrigation.
PRESENTATION OF CASE
A 31-year-old woman was diagnosed with lumbar-3 tuberculosis and paravertebral abscess and underwent emergency spinal surgery in a prone position. After removing the tuberculous pus, 200 mL of HO (3 % v/w) was used to repeatedly irrigate the abscess cavity. Immediately after irrigation, the patient suffered cardiac arrest. During cardiopulmonary resuscitation, transesophageal echocardiography revealed that the right cardiac cavity was filled with a diffuse "Snowflake-Like" gas embolus, and cranial computed tomography showed a multi-point pneumocephalus in the frontal lobes. The patient eventually suffered brain death despite the return of spontaneous circulation after active resuscitation.
DISCUSSION
HO can quickly release abundant oxygen and water upon contact with catalase. Oxygen bubbles enter the vascular lumen and cause mechanical obstruction of the right cardiac circulation. In addition, HO and oxygen bubbles may migrate upwards and enter the intracranial tissue through the epidural space or subdural space, resulting in intracranial pneumatosis. Diagnosis and treatment of gas embolism are extremely difficult. Some suggestions are that HO should not be used in closed cavities or on deep and large wounds due to the potential risk of fatal gas embolism.
CONCLUSION
The fatal complications of gas embolism and pneumocephalus rarely occur simultaneously in one patient, and we aim to highlight this potential risk of intraoperative HO use in spinal surgery.
PubMed: 38367418
DOI: 10.1016/j.ijscr.2024.109387 -
Neurology Mar 2024
Topics: Humans; Meningioma; Pneumocephalus; Postoperative Complications; Meningeal Neoplasms
PubMed: 38330284
DOI: 10.1212/WNL.0000000000209185 -
Journal of Neurosurgery. Case Lessons Feb 2024Osteoid osteoma is a common benign bone tumor frequently seen in the frontoethmoid region. However, involvement of the skull base is rare, with few cases previously...
BACKGROUND
Osteoid osteoma is a common benign bone tumor frequently seen in the frontoethmoid region. However, involvement of the skull base is rare, with few cases previously reported.
OBSERVATIONS
The authors report two cases of spontaneous, symptomatic frontoethmoidal osteoma: one presented with neurological deficit secondary to tension pneumocephalus and the other with cerebrospinal fluid leakage. The first case was managed with a transfrontal sinus craniotomy and pneumocephalus decompression with osteoma resection and skull base reconstruction. The second case was managed with a uninaral endoscopic endonasal approach to the anterior skull base with osteoma resection and reconstruction.
LESSONS
Given the paucity of cases with associated tension pneumocephalus described in the literature, it was relevant to describe the authors' experience with surgical decision-making and the expected outcomes among patients with this pathology when using minimally invasive techniques.
PubMed: 38315987
DOI: 10.3171/CASE23699 -
Cureus Dec 2023A subdural hematoma (SDH) is a medical condition caused by a violent head trauma in which blood accumulates excessively under the dura mater. It occurs when a blood...
Early Mobilization and Rehabilitation to Enhance the Functional Performance of a Hemiparesis Patient Following a Subdural and Subarachnoid Hematoma With Pneumocephalus: A Case Report.
A subdural hematoma (SDH) is a medical condition caused by a violent head trauma in which blood accumulates excessively under the dura mater. It occurs when a blood arterial weak point or brain surface aneurysm ruptures and bleeds. The resulting blood accumulation inside and around the skull raises the pressure on the brain. Pneumocephalus, also known as pneumatocele or intracranial aerogel, refers to air in the ventricular cavities or brain parenchyma's epidural, subdural, or subarachnoid spaces. In most cases, neurotrauma is the primary cause of pneumocephalus, mainly when there are skull base fractures. Here, we present a case study of a 65-year-old male patient diagnosed with left hemiplegia following SDH with subarachnoid hematoma (SAH) and pneumocephalus. The severity of the patient's illness, the medical and surgical care provided, the amount of physiotherapy required to aid recovery, the duration of hospitalization, and the discharge location for patients with acute SAH or SDH vary significantly. The patient underwent physiotherapy rehabilitation, and we report that his lower limb strength improved substantially after the therapy. Therefore, physiotherapy is a critical component of treatment to enhance muscle strength, facilitate early and rapid recovery, and manage the clinical manifestations of the condition.
PubMed: 38288164
DOI: 10.7759/cureus.51199 -
Stereotactic and Functional Neurosurgery 2024Deep brain stimulation (DBS) is a routine neurosurgical procedure utilized to treat various movement disorders including Parkinson's disease (PD), essential tremor (ET),...
INTRODUCTION
Deep brain stimulation (DBS) is a routine neurosurgical procedure utilized to treat various movement disorders including Parkinson's disease (PD), essential tremor (ET), and dystonia. Treatment efficacy is dependent on stereotactic accuracy of lead placement into the deep brain target of interest. However, brain shift attributed to pneumocephalus can introduce unpredictable inaccuracies during DBS lead placement. This study aimed to determine whether intracranial air is associated with brain shift in patients undergoing staged DBS surgery.
METHODS
We retrospectively evaluated 46 patients who underwent staged DBS surgery for PD, ET, and dystonia. Due to the staged nature of DBS surgery at our institution, the first electrode placement is used as a concrete fiducial marker for movement in the target location. Postoperative computed tomography (CT) images after the first electrode implantation, as well as preoperative, and postoperative CT images after the second electrode implantation were collected. Images were analyzed in stereotactic targeting software (BrainLab); intracranial air was manually segmented, and electrode shift was measured in the x, y, and z plane, as well as a Euclidian distance on each set of merged CT scans. A Pearson correlation analysis was used to determine the relationship between intracranial air and brain shift, and student's t test was used to compare means between patients with and without radiographic evidence of intracranial air.
RESULTS
Thirty-six patients had pneumocephalus after the first electrode implantation, while 35 had pneumocephalus after the second electrode implantation. Accumulation of intracranial air following the first electrode implantation (4.49 ± 6.05 cm3) was significantly correlated with brain shift along the y axis (0.04 ± 0.35 mm; r (34) = 0.36; p = 0.03), as well as the Euclidean distance of deviation (0.57 ± 0.33 mm; r (34) = 0.33; p = 0.05) indicating statistically significant shift on the ipsilateral side. However, there was no significant correlation between intracranial air and brain shift following the second electrode implantation, suggesting contralateral shift is minimal. Furthermore, there was no significant difference in brain shift between patients with and without radiographic evidence of intracranial air following both electrode implantation surgeries.
CONCLUSION
Despite observing volumes as high as 22.0 cm3 in patients with radiographic evidence of pneumocephalus, there was no significant difference in brain shift when compared to patients without pneumocephalus. Furthermore, the mean magnitude of brain shift was <1.0 mm regardless of whether pneumocephalus was presenting, suggesting that intracranial air accumulation may not produce clinical significant brain shift in our patients.
Topics: Humans; Deep Brain Stimulation; Dystonia; Retrospective Studies; Pneumocephalus; Magnetic Resonance Imaging; Electrodes, Implanted; Brain; Parkinson Disease; Essential Tremor; Dystonic Disorders
PubMed: 38286119
DOI: 10.1159/000535197