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Turkish Neurosurgery 2016Tension pneumocephalus is an uncommon and life-threatening neurological condition. It requires emergent and immediate attention to prevent fatal complications. Head... (Review)
Review
Tension pneumocephalus is an uncommon and life-threatening neurological condition. It requires emergent and immediate attention to prevent fatal complications. Head injury is the most common cause of tension pneumocephalus. Air can gain access into the cranium either through a fracture involving paranasal sinus or the middle ear cavity or even more rarely in association with a compound depressed fracture of the skull vault. Its management includes simple twist drill and aspiration of intracranial air with or without placement of an under water seal. 100% oxygen should be administered by a non-breatheable mask which hastens the resorption of air. The authors report a series of 4 cases of post-traumatic tension pneumocephalus, highlighting its management, and review the pertinent literature.
Topics: Adult; Female; Humans; Male; Middle Aged; Neurosurgical Procedures; Pneumocephalus; Skull Fractures
PubMed: 26956830
DOI: 10.5137/1019-5149.JTN.4238-11.1 -
Ear, Nose, & Throat Journal Apr 2024Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus...
Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus include headache, lethargy, confusion, disorientation, and seizure. Here, we have reported a case of a 42-year-old woman with extensive pneumocephalus and cerebrospinal fluid leak secondary to petrous bone cholesteatoma. She presented to the emergency department with sudden headache and left ear discharge. Physical examination revealed watery otorrhea through a hole in the tympanic membrane. Radiological studies demonstrated extensive soft tissue in the left middle ear and mastoid extending to the internal auditory canal. Free intracranial air was observed, and bony destruction was seen in the cochlea, vestibule, and semicircular canals. The patient was managed surgically via the transotic approach and fully recovered. Although otogenic pneumocephalus is rarely encountered in clinical practice, early diagnosis and urgent management are important to prevent fatal complications.
Topics: Female; Humans; Adult; Petrous Bone; Pneumocephalus; Cholesteatoma; Headache; Vestibule, Labyrinth
PubMed: 34587824
DOI: 10.1177/01455613211048966 -
Journal of Medical Case Reports May 2023Epidural anesthesia is commonly used for analgesia during labor, and headache is a common complaint following this procedure. Pneumocephalus, on the other hand, is a...
INTRODUCTION
Epidural anesthesia is commonly used for analgesia during labor, and headache is a common complaint following this procedure. Pneumocephalus, on the other hand, is a rare and potentially serious complication of epidural anesthesia, which is most often caused by accidental puncture of the dura with the introduction of air into intrathecal space.
CASE PRESENTATION
We present the case of a 19-year-old Hispanic female who developed a severe frontal headache and neck pain eight hours following epidural catheter placement to deliver analgesia during labor. Physical examination was within normal limits without any neurological deficits. Computed tomography of the head and neck would later demonstrate small to moderate amounts of pneumocephalus, predominantly within the frontal horn of the lateral ventricles, and a moderate amount of air within the spinal canal. She was treated conservatively with analgesia. Though headache recurred after discharge, repeat imaging showed improvement in the volume of pneumocephalus and conservative management was continued.
CONCLUSIONS
Although a rare complication and an uncommon cause of headache following epidural anesthesia, a high index of suspicion must remain for pneumocephalus as it may cause significant morbidity and, in some cases, be potentially life-threatening.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Analgesia, Epidural; Pneumocephalus; Headache; Labor, Obstetric; Pain Management
PubMed: 37231513
DOI: 10.1186/s13256-023-03955-5 -
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 -
Surgical Neurology International 2022Confirmation of whether a stereotactic biopsy was performed in the correct site is usually dependent on the frozen section or on novel tumor-specific markers that are...
BACKGROUND
Confirmation of whether a stereotactic biopsy was performed in the correct site is usually dependent on the frozen section or on novel tumor-specific markers that are not widely available. Immediate postoperative computed tomography (CT) or magnetic resonance (MR) is routinely performed in our service after biopsy. In this retrospective study, we have carefully analyzed these images in an attempt to determine the presence of markers that indicate appropriate targeting.
METHODS
Medical records and neuroimages of patients who underwent stereotactic biopsy of intracranial lesions were reviewed. The following variables were assessed: age, sex, anatomopathology, lesion site, complications, diagnostic accuracy, and the presence of image markers.
RESULTS
Twenty-nine patients were included in this case series. About 96.6% of the biopsies were accurate according to the permanent section. Of the 86.2% of patients with intralesional pneumocephalus on the postoperative images, 51.7% additionally presented petechial hemorrhage. In 13.8% of the cases, no image markers were identified.
CONCLUSION
This is the first report of intralesional pneumocephalus and petechial hemorrhage as indicators of appropriate targeting in stereotactic biopsy. In the majority of the cases, an immediate postoperative head CT, which is widely available, can estimate how adequate the targeting is. To use intralesional pneumocephalus/ petechial hemorrhages as not only postoperative but also as intraoperative markers of appropriate targeting, it is advised that the surgical wound should be temporarily closed and dressed after the biopsy so that the patient can undergo a CT/MR scan and be checked for the presence of theses markers before removing the stereotactic frame.
PubMed: 35855128
DOI: 10.25259/SNI_246_2022 -
Diagnostics (Basel, Switzerland) Dec 2022Tension pneumocephalus is a neurosurgical emergency that occurs when air is trapped in the intracranial cavity, leading to brain compression and causing severe...
Tension pneumocephalus is a neurosurgical emergency that occurs when air is trapped in the intracranial cavity, leading to brain compression and causing severe neurological symptoms such as decreases in motor function, sensory function, and consciousness. Most cases of pneumocephalus require conservative treatment; however, because of the possible fatal complications, rapid diagnosis and appropriate treatment are important. Here, we present the case of an 81-year-old male patient who had undergone head trauma three hours prior to being admitted to our emergency room (ER) because of mental cloudiness. The radiologic findings showed tension pneumocephalus caused by an ethmoidal roof fracture. Emergency reconstruction of the ethmoidal roof with craniotomy was performed to remove the intracranial air using normal saline irrigation. By sharing our experience with this case, we hope to provide an option for the treatment of such cases.
PubMed: 36611383
DOI: 10.3390/diagnostics13010092 -
Annals of Medicine and Surgery (2012) Feb 2022Pneumorachis, air in the spinal canal, is very rare and its association with pneumocephalus following blunt thoracic trauma remains exceptionally uncommon.
INTRODUCTION
Pneumorachis, air in the spinal canal, is very rare and its association with pneumocephalus following blunt thoracic trauma remains exceptionally uncommon.
CASE PRESENTATION
We present the case of a 65-year-old patient, a pedestrian hit by a car driving at very high speed. The lesion assessment on admission showed a bilateral hemothorax of moderate abundance, a right pneumothorax of low abundance and a left pneumothorax of moderate abundance, subcutaneous cervico-dorsal emphysema, pneumocephalus and significant pneumorachis at the cervico-dorsal level without fracture of the base of the skull, sinuses or the spine.
DISCUSSION
We discuss the different etiologies of pneumorachis, the main hypotheses of the constitution of this air effusion and the principles of management.
CONCLUSION
Pneumorachis associated with pneumocephalus in a traumatic context without bone lesions is an extremely rare entity, its discovery should lead to further investigations to look for any spinal or basilar skull fracturethat could expose to an infectious risk or require a surgical procedure.
PubMed: 35198174
DOI: 10.1016/j.amsu.2022.103349 -
Neurology India 2011
Topics: Humans; Magnetic Resonance Imaging; Male; Pneumocephalus; Spinal Cord; Subarachnoid Space; Tomography, X-Ray Computed; Young Adult
PubMed: 21339690
DOI: 10.4103/0028-3886.76883 -
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 -
Ear, Nose, & Throat Journal Jan 2022Pneumocephalus is usually induced by trauma, infections, tumors of the skull base, and surgical interventions. Spontaneous pneumocephalus occurs due to a defect in the...
Pneumocephalus is usually induced by trauma, infections, tumors of the skull base, and surgical interventions. Spontaneous pneumocephalus occurs due to a defect in the temporal bone with no obvious cause. Few cases have been reported with spontaneous otogenic pneumocephalus. However, delayed postoperative pneumocephalus is rarely reported in the literature. Here, we present a case of otogenic pneumocephalus through Eustachian tube (ET) preceded by nose blowing 10 days after surgical treatment of meningoencephalocele of the right middle ear (ME) cleft and reconstruction of tegmen and dural defects. Pneumocephalus was provoked by decreased intracranial pressure (ICP) secondary to placement of lumbar drain, which caused direct communication between unsutured dural defect and the defective posterior wall of external auditory canal skin. A revision surgery of combined transmastoid/middle cranial fossa approach was performed for intracranial decompression followed by appropriate closure by suturing the dura, obliterating the ET and ME.
Topics: Ear, Middle; Encephalocele; Eustachian Tube; Humans; Male; Middle Aged; Nose; Otitis Media, Suppurative; Pneumocephalus; Postoperative Complications; Reoperation; Temporal Bone; Tomography, X-Ray Computed
PubMed: 32543228
DOI: 10.1177/0145561320934217