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Ear, Nose, & Throat Journal Sep 2021Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related...
Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related complications have also been reported. Here, we report a case of pneumocephalus and cerebrospinal fluid leak following BSD of the frontal sinus. Additionally, a review of the literature regarding BSD complications was performed.
Topics: Aged; Dilatation; Frontal Sinus; Humans; Male; Neuroimaging; Paranasal Sinus Diseases; Pneumocephalus; Skull Base; Tomography, X-Ray Computed
PubMed: 34392735
DOI: 10.1177/01455613211037629 -
Case Reports in Critical Care 2021Transsphenoidal surgery (TSS) is a frequently used technique to remove pituitary adenomas. Rare complications of TSS include development of postoperative pneumocephalus....
Transsphenoidal surgery (TSS) is a frequently used technique to remove pituitary adenomas. Rare complications of TSS include development of postoperative pneumocephalus. Many patients undergoing TSS also suffer from obstructive sleep apnea (OSA) and thus require positive pressure ventilation. The exact timing of when to safely reintroduce the CPAP machine in this subset of patients is presently not exactly known but is most often cited as being two to four weeks postoperatively. In this case, we describe the story of a 69-year-old female who underwent TSS for a nonsecreting pituitary adenoma in April 2012 and went on to develop pneumocephalus five weeks postoperatively after reintroduction of her CPAP machine. This is the latest presentation of pneumocephalus after reintroduction of CPAP documented in present literature. The case reopens the debate as to how many weeks postoperatively positive pressure ventilation should be withheld to prevent the development of pneumocephalus in patients having undergone TSS with simultaneous OSA.
PubMed: 34394994
DOI: 10.1155/2021/8855879 -
Case Reports in Otolaryngology 2017Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality.
OBJECTIVE
Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality.
MATERIAL AND METHOD
We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs.
RESULT
Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication.
CONCLUSION
Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.
PubMed: 29312790
DOI: 10.1155/2017/7878646 -
Neurology. Clinical Practice Oct 2015Headache resulting from dural puncture in epidural and spinal anesthesia is usually secondary to a CSF leak. Pneumocephalus may also occur in this setting but has not...
Headache resulting from dural puncture in epidural and spinal anesthesia is usually secondary to a CSF leak. Pneumocephalus may also occur in this setting but has not been well-characterized. Although the risk factors for a CSF leak and pneumocephalus may overlap, their rates, clinical features, and treatments may be different. Our retrospective review of 182 patients with acute headache in the antepartum, peripartum, and postpartum settings yielded a 5:1 ratio of postdural puncture headache to pneumocephalus. The 3 patients with pneumocephalus had the defining characteristic of thunderclap headache during anesthesia. Early diagnosis is helpful as treatment with supplemental oxygen may hasten recovery. Pneumocephalus should be considered as a possible etiology of thunderclap headache in the setting of epidural and spinal anesthesia.
PubMed: 29443169
DOI: 10.1212/CPJ.0000000000000178 -
Proceedings (Baylor University. Medical... Oct 2018Pneumocephalus after trauma is not uncommon but rarely develops into tension pneumocephalus. Delayed-onset spontaneous tension pneumocephalus is rare, and delayed-onset...
Pneumocephalus after trauma is not uncommon but rarely develops into tension pneumocephalus. Delayed-onset spontaneous tension pneumocephalus is rare, and delayed-onset isolated intraparenchymal/intracerebral tension pneumocephalus is even more so. We describe a 35-year-old man who presented with urinary incontinence, left eye vision loss, and nasal discharge/cerebrospinal fluid rhinorrhea 2 months after recovering from bifrontal hemorrhagic contusions following a road traffic accident. Intraparenchymal/intracerebral tension pneumocephalus was diagnosed with computed tomography and the patient was taken for an urgent decompressive surgery along with repair of the skull base defect.
PubMed: 30949006
DOI: 10.1080/08998280.2018.1498680 -
International Journal of Surgery Case... 2020Trauma-related pneumocephalus and subcutaneous emphysema are relatively common, but pneumocephalus and pneumorrachis that occur without surgery are very rare. We present...
BACKGROUND
Trauma-related pneumocephalus and subcutaneous emphysema are relatively common, but pneumocephalus and pneumorrachis that occur without surgery are very rare. We present a case of pneumorrachis and pnemocephalus developing in the literature for the first time after stabbing from the anterior cervical region and providing improvement with conservative treatment.
CASE PRESENTATION
A 42-year-old male patient was brought to the emergency department after stabbed in the neck. Anteromedial injury of the sternocloid muscle was followed by two lacerations with active bleeding from the same site. The patient was unconscious (Glasgow coma score 8(E2, M4, V2). The patient was intubated. Bleeding foci and lacerations were repaired in the emergency. Cranial, cervical, thoracic and lumbar non-contrast computed tomography scans were performed. Moderate pneumocephalus was seen in the subarachnoid space in the anterior of the bilateral frontal lobe and in the suprasellar cistern region. Pneumorrachis was seen in C2-C7 levels of cervical spinal canal. The patient was pentotalized. 100% oxygen treatment for 6 h was given from the ventilator in intensive unit. After 72 h, cranial, cervical, thoracic and lumbar CT were performed. Pneumorrachis and pneumocephalus were fully recovered.
CONCLUSION
Pneumorrachis is usually asymptomatic and is self-limiting. It is a radiological diagnosis and is not a clinical diagnosis. CT scan is considered the preferred diagnostic method for reliable and rapid detection of pneumorrachis. In case of coexistence, The physician should be alert to diagnose and treat the underlying cause for related injuries.In such cases, successful results can be obtained with hyper-oxy therapy (100% oxygen inhalation) and antibiotic prophylaxis without the need for surgical treatment.
PubMed: 32251988
DOI: 10.1016/j.ijscr.2020.02.031 -
European Journal of Case Reports in... 2023A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental...
UNLABELLED
A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental status. There was placement of a ventriculoperitoneal shunt in 1970 complicated by meningitis, leading to removal of the material and ventriculociternostomy as definitive treatment in 2004. About one month previously, she had undergone a laparoscopic cholecystectomy complicated by an intra-abdominal collection. Clinical examination at the emergency department revealed a Glasgow score of 8 (E3 V1 M4). In the emergency department the patient presented a tonic-clonic seizure before a cerebral CT scan was performed showing a massive compressive pneumocephalus, then a second seizure. The patient was finally admitted to the neurosurgery department and underwent surgery.
LEARNING POINTS
Changes in mental status in a patient with a history of chronic hydrocephalus should alert clinicians to a possible complication.This case reflects the delayed diagnosis of a critically ill patient in the emergency department.
PubMed: 38077697
DOI: 10.12890/2023_004160 -
European Journal of Case Reports in... 2020Lumbar epidural anaesthesia is a commonly used technique for analgesia during labour. One of the rare complications of this technique is pneumocephalus.
INTRODUCTION
Lumbar epidural anaesthesia is a commonly used technique for analgesia during labour. One of the rare complications of this technique is pneumocephalus.
CASE DESCRIPTION
We report the case of a 35-year-old female admitted to the Emergency Department with severe headache associated with fast head movements. Five days previously she had a eutocic delivery and lumbar epidural anaesthesia was performed. A brain computed tomography (CT) scan showed pneumocephalus and she was admitted to the hospital ward. A brain CT scan on the fourth day of hospitalization showed resolution of ventricular pneumocephalus.
DISCUSSION
The most frequently occurring symptom with pneumocephalus is headache associated with fast brain motion resulting from air injection and meningeal irritation. When there is clinical suspicion of pneumocephalus, a brain CT scan should be performed for the diagnosis.
LEARNING POINTS
Pneumocephalus is the presence of air in the intracranial cavity and its development after spinal or epidural anaesthesia is extremely infrequent.Headache that occurs in the setting of lumbar epidural anaesthesia should not be labelled as post-dural puncture headache.The suspicion of pneumocephalus, based on the characteristics of the headache, should be maintained to obtain an emergent brain CT scan.
PubMed: 32133317
DOI: 10.12890/2020_001425 -
Medicine Dec 2022To investigate the clinical, laboratory, and radiological features of meningitis after lumbar epidural steroid injection (M-ESI) without accompanying spinal infection,...
To investigate the clinical, laboratory, and radiological features of meningitis after lumbar epidural steroid injection (M-ESI) without accompanying spinal infection, data of patients with meningitis admitted between January 2014 and December 2021 in a single center were retrospectively reviewed. Among them, patients with a recent history of lumbar ESI were identified, and their medical records were collected. Patients with concomitant infections other than meningitis, including spinal epidural abscess, were excluded. Seven patients with M-ESI were identified. All patients presented with headache and fever without focal neurological deficits, and headache developed shortly after a procedure (median, 4 hours). Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis (median, 6729/μL), elevated protein level (median, 379.1 mg/dL), decreased ratio of CSF glucose to serum glucose (median, 0.29), and elevated lactate level (median, 8.64 mmol/L). Serum level of C-reactive protein was elevated in 6, but serum procalcitonin level was within normal range. No causative pathogen was identified in the microbiological studies. The most frequent radiologic feature was sulcal hyperintensity on fluid-attenuated inversion recovery images (57%), followed by pneumocephalus (43%). Symptoms subsided in a short period (median, 1 day) after initiating treatment with antibiotics and adjuvant intravenous corticosteroids. None of the patients experienced neurological sequelae. Though the cardinal symptoms and CSF findings of M-ESI were comparable to those of bacterial meningitis, M-ESI seems to have distinctive characteristics regarding the clinical course, laboratory parameters, and pneumocephalus.
Topics: Humans; Pneumocephalus; Retrospective Studies; Meningitis, Bacterial; Headache; Steroids
PubMed: 36595762
DOI: 10.1097/MD.0000000000032396 -
Neurologia Medico-chirurgica Oct 2008A 20-year-old male presented with an extremely rare spontaneous epidural pneumocephalus which was successfully treated by a single neurosurgical intervention. The...
A 20-year-old male presented with an extremely rare spontaneous epidural pneumocephalus which was successfully treated by a single neurosurgical intervention. The patient had a habit of nose blowing and a 1-year history of progressive headache and nausea. Cranial computed tomography (CT) revealed a 2 x 7 cm right temporo-occipital epidural pneumocephalus with extensive hyperpneumatization of the mastoid cells. Right temporo-occipital craniotomy with a right superficial temporal artery and vein flap repair resulted in radiographic resolution of the pneumocephalus, and he remained neurologically free of symptoms at 1-year follow-up examination. Early identification and monitoring of symptomatic pneumocephalus followed by decompression and prevention of infection via closure of the bone defect can avoid possible serious consequences. The underlying mechanisms may involve a congenital petrous bone defect and a ball-valve effect due to excessive nose blowing in our case.
Topics: Adult; Craniotomy; Epidural Space; Headache; Humans; Intracranial Hypertension; Male; Mastoid; Petrous Bone; Pneumocephalus; Surgical Flaps; Temporal Arteries; Temporal Bone; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 18948684
DOI: 10.2176/nmc.48.474