-
Scientific Reports Jun 2022Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain...
Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain shift (PBS). Sixty-seven patients who underwent neurosurgical procedures had upright computed tomography (CT) scan using settings similar to those of conventional supine CT. The presence of a clinically significant PBS, defined as a brain shift of ≥ 5 mm caused by positional change, was evaluated. The clinical and radiological findings were investigated to identify factors associated with a larger PBS. As a result, twenty-one patients had a clinically significant PBS. The univariate analysis showed that supratentorial lesion location, intra-axial lesion type, craniectomy procedure, and residual intracranial air were the predictors of PBS. Based on the multivariate analysis, craniectomy procedure (p < 0.001) and residual intracranial air volume (p = 0.004) were the predictors of PBS. In a sub-analysis of post-craniectomy patients, PBS was larger in patients with supratentorial craniectomy site and parenchymal brain injury. A large craniectomy area and long interval from craniectomy were correlated with the extent of PBS. In conclusion, patients who undergo craniectomy and those with residual intracranial air can present with a large PBS. In post-craniectomy patients, the predisposing factors of a large PBS are supratentorial craniectomy, presence of parenchymal injury, large skull defect area, and long interval from craniectomy. These findings can contribute to safe mobilization among postneurosurgical patients and the risk assessment of sinking skin flap syndrome.
Topics: Brain; Brain Injuries; Craniotomy; Decompressive Craniectomy; Humans; Pneumocephalus; Postoperative Complications; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35729166
DOI: 10.1038/s41598-022-13276-0 -
Tanisal Ve Girisimsel Radyoloji : Tibbi... Mar 2003Imaging in pneumocephalus aids in the diagnosis and management of this condition, which usually results from trauma, iatrogenic causes, infections, tumors, and cranium... (Review)
Review
Imaging in pneumocephalus aids in the diagnosis and management of this condition, which usually results from trauma, iatrogenic causes, infections, tumors, and cranium abnormalities. The role of computed tomography and magnetic resonance imaging is especially addressed in this article.
Topics: Humans; Magnetic Resonance Imaging; Pneumocephalus; Tomography, X-Ray Computed
PubMed: 14661288
DOI: No ID Found -
Acta Neurochirurgica Feb 2019Pneumocephalus, the presence of intracranial air, is a complication especially seen after neurotrauma or brain surgery. When it leads to a pressure gradient, a so-called...
Pneumocephalus, the presence of intracranial air, is a complication especially seen after neurotrauma or brain surgery. When it leads to a pressure gradient, a so-called tension pneumocephalus, it may require emergency surgery. Clinical symptomatology, especially in young children, does not differentiate between a pneumocephalus and a tension pneumocephalus. An additional CT scan is therefore warranted. Here, we report on a rare case of pneumocephalus after penetrating lumbar injury. Additionally, the pathophysiology of pneumocephalus, as well as its recommendations for diagnosis and treatment, will be elucidated.
Topics: Child; Humans; Lumbosacral Region; Male; Pneumocephalus; Spinal Injuries; Tomography, X-Ray Computed; Wounds, Penetrating
PubMed: 30652201
DOI: 10.1007/s00701-018-03796-y -
Korean Journal of Neurotrauma Oct 2017Pneumocephalus is commonly seen after craniofacial injury. The pathogenesis of pneumocephalus has been debated as to whether it was caused by ball valve effect or...
Pneumocephalus is commonly seen after craniofacial injury. The pathogenesis of pneumocephalus has been debated as to whether it was caused by ball valve effect or combined episodic increased pressure within the nasopharynx on coughing. Discontinuous exchange of air and cerebrospinal fluid due to "inverted bottle" effect is assumed to be the cause of it. Delayed tension pneumocephalus is not common, but it requires an active management in order to prevent serious complication. We represent a clinical case of a 57-year-old male patient who fell down from 3 m height, complicated by tension pneumocephalus on 5 months after trauma. We recommend a surgical intervention, but the patient did not want that so we observe the patient. The patient was underwent seizure and meningitis after 7 months after trauma, he came on emergency room on stupor mentality. Tension pneumocephalus may result in a neurologic disturbance due to continued air entrainment and it significantly the likelihood of intracranial infection caused by continued open channel. Tension pneumocephalus threat a life, so need a neurosurgical emergency surgical intervention.
PubMed: 29201853
DOI: 10.13004/kjnt.2017.13.2.158 -
Journal of Neurosciences in Rural... Jul 2019Tension pneumocephalus is a life-threatening condition that is characterized by the accumulation of intracranial air, causing increased intracranial pressure. Paranasal...
Tension pneumocephalus is a life-threatening condition that is characterized by the accumulation of intracranial air, causing increased intracranial pressure. Paranasal sinus osteomas are common, slow-growing benign tumors usually diagnosed incidentally. Paranasal sinus osteomas causing tension pneumocephalus have been very rarely reported.
PubMed: 31595133
DOI: 10.1055/s-0039-1698292 -
Journal of the American Veterinary... Jul 2006A 4-year-old sexually intact female French Bulldog was evaluated because of lethargy, anorexia, and chronic rhinitis-sinusitis. The dog had nasal discharge of 18 months'...
CASE DESCRIPTION
A 4-year-old sexually intact female French Bulldog was evaluated because of lethargy, anorexia, and chronic rhinitis-sinusitis. The dog had nasal discharge of 18 months' duration; dorsal rhinotomies were performed 3 months and 2 weeks prior to referral.
CLINICAL FINDINGS
On initial evaluation, intraventricular pneumocephalus and sinusitis were diagnosed; CSF analysis revealed high total protein concentration and mononuclear pleocytosis. The dog's condition improved with treatment. Two weeks after discharge, it was treated by a local veterinarian because of upper airway obstruction; 3 days later, the dog was referred because of seizures. Computed tomography revealed a large fluid-filled, left lateral ventricle and a soft tissue mass protruding through a cribriform plate defect. The mass was histologically consistent with brain tissue. Findings of clinicopathologic analyses were unremarkable. Results of cytologic examination of a CSF sample were indicative of septic, suppurative inflammation, and bacteriologic culture of CSF yielded Escherichia coli.
TREATMENT AND OUTCOME
Amputation of the herniated olfactory bulb and antimicrobial treatment resolved the septic meningoencephalitis, but neurologic deficits recurred 6 weeks later. Definitive correction of the cribriform plate defect with bone and fascial grafts was attempted. Postoperative rotation of the bone graft resulted in cerebral laceration and hemorrhage, and the dog was euthanized.
CLINICAL RELEVANCE
Findings suggest that following dorsal rhinotomy and nasal polypectomy surgery, the dog developed herniation of the left olfactory bulb, intra-ventricular pneumocephalus, and septic meningo-encephalitis because of a cribriform plate defect. Care must be taken to prevent rotation of bone grafts used in cribriform defect repair.
Topics: Animals; Bone Transplantation; Cerebrospinal Fluid; Dog Diseases; Dogs; Escherichia coli; Escherichia coli Infections; Fatal Outcome; Female; Meningoencephalitis; Nasal Polyps; Neurologic Examination; Pneumocephalus; Tomography, X-Ray Computed
PubMed: 16842045
DOI: 10.2460/javma.229.2.240 -
BMJ Case Reports Nov 2014
Topics: Frontal Sinus; Humans; Male; Orbital Fractures; Pneumocephalus; Radiography; Skull Fractures; Syncope; Young Adult
PubMed: 25425254
DOI: 10.1136/bcr-2014-207755 -
Radiology Case Reports Mar 2021Sometimes the only indicator of a serious infection in a neonate is a fever. has been reported to cause neonatal brain abscesses in the setting of meningitis. Although...
Sometimes the only indicator of a serious infection in a neonate is a fever. has been reported to cause neonatal brain abscesses in the setting of meningitis. Although rare, pneumocephalus, secondary to , carries a very high mortality. A 17-day-old male presented to the emergency department with a fever, decreased oral intake, and lethargy. The patient developed pneumocephalus and cerebral edema and was diagnosed with meningitis, leading to death. This case demonstrates the presentation of meningitis with pneumocephalus and cerebral edema in a neonate presenting with fever.
PubMed: 33384749
DOI: 10.1016/j.radcr.2020.12.039 -
PloS One 2018Postoperative agitation frequently occurs after general anesthesia and may be associated with serious consequences. However, studies in neurosurgical patients have been...
Bi-frontal pneumocephalus is an independent risk factor for early postoperative agitation in adult patients admitted to intensive care unit after elective craniotomy for brain tumor: A prospective cohort study.
UNLABELLED
Postoperative agitation frequently occurs after general anesthesia and may be associated with serious consequences. However, studies in neurosurgical patients have been inadequate. We aimed to investigate the incidence and risk factors for early postoperative agitation in patients after craniotomy, specifically focusing on the association between postoperative pneumocephalus and agitation. Adult intensive care unit admitted patients after elective craniotomy under general anesthesia were consecutively enrolled. Patients were assessed using the Sedation-Agitation Scale during the first 24 hours after operation. The patients were divided into two groups based on their maximal Sedation-Agitation Scale: the agitation (Sedation-Agitation Scale ≥ 5) and non-agitation groups (Sedation-Agitation Scale ≤ 4). Preoperative baseline data, intraoperative and intensive care unit admission data were recorded and analyzed. Each patient's computed tomography scan obtained within six hours after operation was retrospectively reviewed. Modified Rankin Scale and hospital length of stay after the surgery were also collected. Of the 400 enrolled patients, agitation occurred in 13.0% (95% confidential interval: 9.7-16.3%). Body mass index, total intravenous anesthesia, intraoperative fluid intake, intraoperative bleeding and transfusion, consciousness after operation, endotracheal intubation kept at intensive care unit admission and mechanical ventilation, hyperglycemia without a history of diabetes, self-reported pain and postoperative bi-frontal pneumocephalus were used to build a multivariable model. Bi-frontal pneumocephalus and delayed extubation after the operation were identified as independent risk factors for postoperative agitation. After adjustment for confounding, postoperative agitation was independently associated with worse neurologic outcome (odd ratio: 5.4, 95% confidential interval: 1.1-28.9, P = 0.048). Our results showed that early postoperative agitation was prevalent among post-craniotomy patients and was associated with adverse outcomes. Improvements in clinical strategies relevant to bi-frontal pneumocephalus should be considered.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT02318199).
Topics: Adult; Brain Neoplasms; China; Craniotomy; Elective Surgical Procedures; Female; Humans; Incidence; Intensive Care Units; Male; Middle Aged; Pneumocephalus; Postoperative Complications; Prospective Studies; Retrospective Studies; Risk Factors
PubMed: 30024979
DOI: 10.1371/journal.pone.0201064 -
NMC Case Report Journal Apr 2021Pneumocephalus is generally secondary to direct damage to the skull base. Spontaneous intracerebral pneumatocele without head injury was extremely rare, but previously...
Pneumocephalus is generally secondary to direct damage to the skull base. Spontaneous intracerebral pneumatocele without head injury was extremely rare, but previously reported as a serious complication of shunt procedures. We describe a 40-year-old man with intracerebral pneumocephalus who previously underwent craniotomy for large frontal convexity meningioma and lumbo-peritoneal shunting. He presented with gait disturbance 14 months after tumor resection. Computed tomography and magnetic resonance imaging showed intracerebral pneumocephalus in the right temporal lobe, which continued into the mastoid air cells through a bone defect of the right petrous bone. We performed urgent right temporal craniotomy to reduce the mass effect and to repair the fistula. Intraoperatively, bone defects were identified at the roof petrous bone, into which the encephalocele had penetrated. The herniated cerebral parenchyma was removed, and the pneumocephalus opened. The dura was closed with sutures and covered with fascia. To elucidate the underlying mechanism for the development of intracranial pneumocephalus, the previous images obtained before or immediately after resection of meningioma were reviewed. We founded that multiple preexisting bone defects and encephaloceles, one of which was considered to be the cause of the intracerebral pneumocephalus. This case demonstrates that intracerebral pneumocephalus can be caused by preexisting bone defect and encephalocele, and this finding may be useful for prediction of pneumocephalus after shunt procedures.
PubMed: 34012747
DOI: 10.2176/nmccrj.cr.2020-0074