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Chinese Neurosurgical Journal Aug 2022Postoperative pneumocephalus is associated with a higher risk of recurrence of chronic subdural hematoma (cSDH). However, there is no verified simple way to measure the...
BACKGROUND
Postoperative pneumocephalus is associated with a higher risk of recurrence of chronic subdural hematoma (cSDH). However, there is no verified simple way to measure the pneumocephalus volume at the bedside for daily clinical use. The ABC/2 method was shown to be a simple and reliable technique to estimate volumes of intracranial lesions, such as intracranial hematomas. This study aims to evaluate the accuracy of the ABC/2 formula in estimating volumes of pneumocephalus, as compared to the gold standard with computer-assisted volumetric analysis.
METHODS
A total of 141 postoperative computed tomographic (CT) brain scans of cSDH patients with burr-hole drainage were analysed. Pneumocephalus volume was measured independently by both the ABC/2 formula and the computer-assisted volumetric measurement. For the computer-assisted measurement, the volume of the air was semiautomatically segmented and calculated by computer software. Linear regression was used to determine the correlation between the ABC/2 method and computer-assisted measurement.
RESULTS
The postoperative pneumocephalus volume after bilateral burr-hole drainage was significantly larger than that of unilateral burr-hole drainage (29.34 ml versus 12.21 ml, p < 0.001). The estimated volumes by the formula ABC/2 significantly correlated to the volumes as measured by the computer-assisted volumetric technique, with r = 0.992 (p < 0.001). The Pearson correlation coefficient is very close to 1, which signifies a very strong positive correlation, and it is statistically significant.
CONCLUSIONS
An excellent correlation is observed between the ABC/2 method and the computer-assisted measurement. This study verified that the ABC/2 method is an accurate and simple "bedside" technique to estimate pneumocephalus volume.
PubMed: 35922864
DOI: 10.1186/s41016-022-00287-z -
Cureus Apr 2018Pneumocephalus, the presence of air within the cranium, commonly suggests a breach in the meningeal layer or an intracranial infection by a gas-producing organism....
Pneumocephalus, the presence of air within the cranium, commonly suggests a breach in the meningeal layer or an intracranial infection by a gas-producing organism. Trauma is the most common cause of pneumocephalus, followed by cranial surgery. Other causes include infection and intracranial neoplasm. An 87-year-old man was conveyed to the emergency department after being found to be drowsy by his helper. He was noted to have a new onset right-sided hemiparesis. Past medical history was significant for hypertension, stage 5 chronic kidney disease, cerebrovascular accident, pacemaker insertion for sick sinus syndrome, transurethral resection of the prostate for benign prostatic hyperplasia, and pulmonary tuberculosis. Computed tomography (CT) of the brain revealed pneumocephalus with air within the dural venous sinuses. A facial bone CT that was performed to look for a fracture demonstrated a minimally displaced fracture of the lateral wall of the right maxillary sinus. There was an acute left middle cerebral artery territory infarct with a hemorrhagic conversion. Despite medical treatment, the patient demised one month after the initial presentation. Pneumocephalus is an uncommon finding, even in trauma. In the event that the clinical presentation cannot be explained by the mere presence of air within the cranium, another diagnosis ought to be sought. The delay in finding an alternative diagnosis and its management can be disastrous or even fatal.
PubMed: 29922521
DOI: 10.7759/cureus.2480 -
International Journal of Surgery Case... 2017Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly.
INTRODUCTION
Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly.
CASE PRESENTATION
We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43- year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury.
CONCLUSIONS
These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.
PubMed: 28152490
DOI: 10.1016/j.ijscr.2017.01.038 -
Journal of Neurological Surgery. Part... Aug 2019This study is aimed to report the largest independent case series of spontaneous otogenic pneumocephalus (SOP) and review its pathophysiology, clinical presentation,...
This study is aimed to report the largest independent case series of spontaneous otogenic pneumocephalus (SOP) and review its pathophysiology, clinical presentation, and treatment. Four patients underwent a middle cranial fossa approach for repair of the tegmen tympani and tegmen mastoideum. A comprehensive review of the literature regarding this disease entity was performed. U.S. tertiary academic medical center. Patients presenting to the lead author's clinic or to the emergency department with radiographic evidence of SOP. Symptoms included headache, otalgia, and neurologic deficits. Patients were assessed for length of stay, postoperative length of stay, and neurologic outcome. Three of four patients returned to their neurologic baseline following repair. Four patients were successfully managed via a middle cranial fossa approach to repairing the tegmen mastoideum. The middle cranial fossa approach is an effective strategy to repair defects of the tegmen mastoideum. SOP remains a clinically rare disease, with little published information on its diagnosis and treatment.
PubMed: 31316888
DOI: 10.1055/s-0038-1676036 -
Medicina 2016
Topics: Adult; Head Injuries, Penetrating; Humans; Male; Pneumocephalus; Tomography, X-Ray Computed; Trauma Severity Indices
PubMed: 27295712
DOI: No ID Found -
Acute Medicine & Surgery 2024Traumatic pneumocephalus is commonly encountered after basal skull fractures and rarely associated with blunt chest trauma. Here, we report a case of pneumocephalus...
BACKGROUND
Traumatic pneumocephalus is commonly encountered after basal skull fractures and rarely associated with blunt chest trauma. Here, we report a case of pneumocephalus caused by traumatic pneumothorax and brachial plexus avulsion.
CASE PRESENTATION
A 20-year-old male was admitted to our hospital following a motorcycle accident with complete paralysis of the right upper limb. 2 days later, follow-up computed tomography revealed a slight right pneumothorax, pneumomediastinum around the neck, and intracranial air without skull fracture. Air migrates into the subarachnoid space through a dural tear caused by a brachial plexus avulsion. The pneumocephalus immediately improved after the insertion of a chest drain.
CONCLUSION
Pneumothorax combined with brachial plexus avulsion could lead to pneumocephalus. Immediate chest drainage might be the best way to stop the migration of air; however, care should be taken to not worsen cerebrospinal fluid leakage.
PubMed: 38765777
DOI: 10.1002/ams2.956 -
Indian Journal of Critical Care... Jul 2020High-flow nasal cannula (HFNC) therapy has been established as a promising oxygen treatment with various advantages for respiratory mechanics. One of the main mechanisms...
UNLABELLED
High-flow nasal cannula (HFNC) therapy has been established as a promising oxygen treatment with various advantages for respiratory mechanics. One of the main mechanisms is to provide positive airway pressure. This effect could reduce lung injury and improve oxygenation; conversely, it may cause a complication of positive pressure ventilation. However, data are scarce regarding the possible adverse effects, particularly in adults. We report a patient who developed HFNC-induced tension pneumocephalus from an unrecognized skull base fracture. Physicians should be cautious when applying HFNC to patients with suspected skull base or paranasal sinus fracture, especially when applying a higher flow rate.
HOW TO CITE THIS ARTICLE
Chang Y, Kim T-G, Chung S-Y. High-flow Nasal Cannula-induced Tension Pneumocephalus. Indian J Crit Care Med 2020;24(7):592-595.
PubMed: 32963447
DOI: 10.5005/jp-journals-10071-23482 -
Revista de Neurologia
Topics: Adult; Humans; Male; Pneumocephalus
PubMed: 17311217
DOI: No ID Found -
Frontiers in Neurology 2024
PubMed: 38765266
DOI: 10.3389/fneur.2024.1391270 -
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