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Cureus Aug 2023Pneumocephalus, or air entrapment within the cranium, is a rare but dangerous condition with a variety of causes, including trauma, surgery, or predisposing infection....
Pneumocephalus, or air entrapment within the cranium, is a rare but dangerous condition with a variety of causes, including trauma, surgery, or predisposing infection. Trauma is the most common etiology, as fractures provide easy access for air to become entrapped in the cranium. However, access such as via the central nervous system with leak exists. Though not as common as traumatic pneumocephalus, pneumocephalus secondary to infection is a dangerous condition. The literature is sparse on this example of ear-nose-throat infection, making it difficult to form and ascertain guidelines for the management of infectious pneumocephalus and its complications. A 58-year-old man with a history of hypertension, obesity, type 2 diabetes mellitus, and obstructive sleep apnea who presented with a complicated case of acute otitis media associated with subdural empyema, pneumocephalus, and group A Streptococcus is presented in this case report. We describe the course of his hospital stay, management, and current infectious disease guidelines. Given the paucity of cases of infectious pneumocephalus secondary to otitis media, we aim to provide further representation for this important illness as well as encourage the use of a multimodal team of providers. In our case, it was necessary to involve the ear-nose-throat specialist as well as infectious disease and neurocritical care services.
PubMed: 37727174
DOI: 10.7759/cureus.43756 -
Der Anaesthesist May 2022
Topics: Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Female; Hematoma, Subdural; Humans; Pneumocephalus; Post-Dural Puncture Headache; Pregnancy
PubMed: 34923591
DOI: 10.1007/s00101-021-01077-5 -
Journal of the Chinese Medical... Feb 2016Post-traumatic cerebrospinal fluid (CSF) leakage is one of the most troublesome conditions associated with head trauma. CSF fistulae, meningitis/central nervous...
BACKGROUND
Post-traumatic cerebrospinal fluid (CSF) leakage is one of the most troublesome conditions associated with head trauma. CSF fistulae, meningitis/central nervous infection, or even death may accompany it. Few studies have discussed post-traumatic CSF leakage as a risk factor in mortality following head trauma. We conducted this cohort study to examine the issue.
METHODS
We reviewed the records in the Taiwan Traumatic Brain Injury (TBI) Registry System between 1993 and 2008. The study group included patients with acute TBI and post-traumatic CSF leakage, and the control group included cases with TBI but without CSF leakage, selected randomly at a 5:1 ratio with respect to the study group. The demographic data, Glasgow Coma Scale, brain computerized tomography, association of skull fractures and intracranial lesions, and 1-year mortality rates between these two cohorts were reviewed meticulously and analyzed statistically.
RESULTS
Of 174,236 cases, 1773 with post-traumatic CSF leakage were included in the study group, and 8865 cases in the control group. Of the total 10,638 sampled cases, 406 (3.8%) died during the 1-year follow-up period, 159 (9.0%) cases in the CSF leakages group, and 247 (2.8%) in the control group. The patients with CSF leakage had a significantly higher mortality rate within 1 year (adjusted hazard ratio = 1.44, p < 0.001) than those without. We divided the CSF leakage group into three subgroups: otorrhea (n = 568), rhinorrhea (n = 302), and tension pneumocephalus (n = 903). The mortality rates were 8.5% (48/568) in the otorrhea subgroup, 10.9% (33/302) in the rhinorrhea subgroup, and 8.6% (78/903) in the tension pneumocephalus subgroup. The cases with CSF rhinorrhea had a significantly higher mortality rate than the other two subgroups (p < 0.05). All three subgroups had significantly higher mortality rates than the control group during the 1-year follow-up period (adjusted hazard ratios = 2.29, 1.35, and 1.32 in the rhinorrhea, tension pneumocephalus, and otorrhea subgroups, respectively).
CONCLUSION
Post-traumatic CSF leakages had higher mortality rates than those without CSF leakages in TBI cases, and the cases with CSF rhinorrhea had worse outcomes compared with CSF leakages with pneumocephalus or otorrhea.
Topics: Adolescent; Adult; Aged; Brain Injuries, Traumatic; Cerebrospinal Fluid Leak; Cranial Nerve Injuries; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk; Skull Fractures; Trauma Severity Indices
PubMed: 26617240
DOI: 10.1016/j.jcma.2015.10.002 -
Iranian Journal of Otorhinolaryngology May 2018Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously...
INTRODUCTION
Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy.
CASE REPORT
A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.
CONCLUSION
Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus
PubMed: 29876334
DOI: No ID Found -
The Journal of International Advanced... Dec 2020Pneumocephalus after cochlear implantation is very rare with five reported cases in the literature. The presence of clinical features in the immediate postoperative... (Review)
Review
Pneumocephalus after cochlear implantation is very rare with five reported cases in the literature. The presence of clinical features in the immediate postoperative period has never been reported, because they occur weeks after surgery. These neurological manifestations can compromise the patient's life; thus, it is important to have proper knowledge and management of these manifestations. We present a case report with a review of the literature. A 35-year-old man began having seizures a few hours after a cochlear implantation. Computed tomography (CT) scan revealed a pneumocephalus and bone defect at the level of the electrode's drilling path, not objected during the surgery. The patient was handled conservatively, and in subsequent reviews, CT objected reabsorption of the pneumocephalus. The presence of a pneumocephalus should be taken into account in the neurological features of a patient with cochlear implant, especially if mastoid bone defects are suspected during surgery. The management of the pneumocephalus will, in most cases, be conservative, consisting of clinical observation and imaging tests. Surgical treatment is reserved for situations in which the clinical manifestations are very symptomatic and when they are tension pneumocephalus.
Topics: Adult; Cochlear Implantation; Cochlear Implants; Humans; Male; Pneumocephalus; Postoperative Complications; Seizures
PubMed: 33136031
DOI: 10.5152/iao.2020.7601 -
Archives of Clinical and Medical Case... 2022There has been a recognizable surge in cosmetic surgery in recent years, partly influenced by social media, and the easy accessibility to such medical procedures. As...
There has been a recognizable surge in cosmetic surgery in recent years, partly influenced by social media, and the easy accessibility to such medical procedures. As with all types of surgery, the risks of complications are real, and in this specific setting, they tend to occur in a younger age group. Here, we discuss a rare complication and subsequent presentation of tension pneumocephalus, following an episode of cardiac arrest in a 58 year old female, during elective cosmetic-facial surgery. Typically, pneumocephalus develops when there are skull or facial bone fractures, and presents characteristically with leakage of cerebrospinal fluid from the ears and/or nose. The absence of the typical clinical signs and the lack of a clinical history or radiologically evidence of skull or facial bone fractions, may result in a delayed diagnosis, permanent brain injury and death. Awareness of such an unusual complication is therefore crucial when considering any surgery to the head and face (including cosmetic surgery), or following prolonged resuscitative efforts, which may well develop days after the inciting event.
PubMed: 36686216
DOI: 10.26502/acmcr.96550553 -
Medicine Jun 2021Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely...
RATIONALE
Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery.
PATIENT CONCERNS
A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16.
DIAGNOSIS
Emergency brain computed tomography revealed massive pneumocephalus.
INTERVENTIONS
Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol.
OUTCOMES
Repeated computed tomography showed complete resolution of the pneumocephalus after five days.
LESSONS
Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.
Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Decompression, Surgical; Diuretics, Osmotic; Drainage; Humans; Liver Neoplasms; Male; Mannitol; Middle Aged; Neoplasm Staging; Neuroimaging; Orthopedic Procedures; Pneumocephalus; Postoperative Complications; Reoperation; Thoracic Vertebrae; Treatment Outcome
PubMed: 34115046
DOI: 10.1097/MD.0000000000026322 -
PloS One 2019This study is to identify the risk factors for postoperative delirium (PODE) in patients undergoing microvascular decompression (MVD) for the treatment of primary... (Clinical Trial)
Clinical Trial
This study is to identify the risk factors for postoperative delirium (PODE) in patients undergoing microvascular decompression (MVD) for the treatment of primary cranial nerve disorders. We retrospectively reviewed the data of 912 patients (354 men, 558 women) with primary cranial nerve disorders (trigeminal neuralgia, 602 patients; hemifacial spasm, 296 patients; glossopharyngeal neuralgia, 14 patients) who underwent MVD in the Neurosurgery Department of Lanzhou University Second Hospital between July 2007 and June 2018. Potential risk factors for PODE were identified using univariate and multivariate stepwise logistic regression analysis.Of the 912 patients, 221 (24.2%) patients developed PODE. Patients with PODE were significantly older and significantly more likely to be male than patients without PODE. A history of hypertension, preoperative carbamazepine therapy, and postoperative sleep disturbance and tension pneumocephalus were independently associated with PODE. Variables such as body-mass index, smoking and drinking habits, cardiac disease, diabetes mellitus, cerebrovascular disease, mean operative time, affected vessel, mean blood loss, postoperative intensive care unit stay, postoperative fever (>38°C), and routine laboratory results were not associated with PODE in our patients.PODE is a common complication after MVD, and is associated with multiple risk factors, including old age, male sex, hypertension, preoperative carbamazepine use, postoperative sleep disturbance, and tension pneumocephalus.
Topics: Age Factors; Aged; Delirium; Female; Hemifacial Spasm; Humans; Male; Microvascular Decompression Surgery; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Sex Factors; Trigeminal Neuralgia
PubMed: 30998697
DOI: 10.1371/journal.pone.0215374 -
Proceedings of the Royal Society of... Mar 1970
Topics: Adult; Brain Diseases; Child; Humans; Male; Mastoid; Pneumocephalus; Radiography; Skull Fractures; Tinnitus
PubMed: 5445566
DOI: No ID Found -
Postgraduate Medical Journal Feb 2002Chronic subdural haematoma is predominantly a disease of the elderly. It usually follows a minor trauma. A history of direct trauma to the head is absent in up to half... (Review)
Review
Chronic subdural haematoma is predominantly a disease of the elderly. It usually follows a minor trauma. A history of direct trauma to the head is absent in up to half the cases. The common manifestations are altered mental state and focal neurological deficit. Neurological state at the time of diagnosis is the most important prognostic factor. Morbidity and mortality is higher in the elderly but outcome is good in patients who undergo neurosurgical intervention.
Topics: Accidental Falls; Age Factors; Aged; Brain; Craniocerebral Trauma; Epilepsy; Hematoma, Subdural, Chronic; Humans; Pneumocephalus; Postoperative Complications; Prognosis; Recurrence; Risk Factors; Tomography, X-Ray Computed
PubMed: 11807186
DOI: 10.1136/pmj.78.916.71