ABSTRACT
Pneumoventricle and liquoric fistula are possible complications of traumatic brain injury (TBI), the main cause of morbimortality related to trauma in Brazil. Liquoric fistulae are more common after direct trauma with skull base fractures. However, pneumoventricle is rare and occurs due to excessive cerebrospinal fluid (CSF) drainage in the presence of a poorly compliant ventricle system, resulting in the influx of air to its interior. The pathophysiology of tension pneumoventricle remains uncertain. However, the traumatic cause is certain andmultiple bone fractures of the face and liquoric fistula may contribute to the process. If symptomatic, the tension pneumoventricle can cause rapid clinical deterioration. The authors aim to report a rare case of post-TBI tension pneumoventricle with complete resolution and without signs of recurrence of the liquoric fistula after surgical treatment.
Subject(s)
Humans , Male , Adult , Pneumocephalus/etiology , Craniocerebral Trauma/complications , Pneumocephalus/surgery , Pneumocephalus/diagnosis , Tomography, X-Ray Computed , Ventriculoperitoneal Shunt , Cerebrospinal Fluid Leak/surgery , Cerebrospinal Fluid Leak/etiologyABSTRACT
An unusual case of spontaneous cerebrospinal fluid (CSF) rhinorrhea with a pneumocephalus is described in a middle-aged woman who presented with a watery nasal discharge for 1 week and headache, vomiting, and fever for 1 day. The neurological examination revealed meningeal signs and bilateral papilledema. The CSF picture suggested pyogenic meningitis, and computed tomography of the brain revealed pneumocephalus. Diagnostic nasal endoscopy showed outpouching of the dura from the left olfactory cleft with a CSF leak and granular nasal mucosa. The defect was repaired surgically, and a biopsy of that area revealed granulomatous changes suggestive of tuberculosis. The patient recovered completely with standard four-drug antitubercular therapy. To our knowledge spontaneous CSF rhinorrhea with pneumocephalus occurring secondary to nasal tuberculosis has not been previously reported.
Subject(s)
Female , Humans , Middle Aged , Antitubercular Agents/therapeutic use , Biopsy , Cerebrospinal Fluid Rhinorrhea/diagnosis , Endoscopy , Nose Diseases/complications , Otorhinolaryngologic Surgical Procedures , Pneumocephalus/diagnosis , Tomography, X-Ray Computed , Treatment Outcome , Tuberculosis/complicationsABSTRACT
Pneumoventricle is a common postoperative event following posterior fossa approach, or any transventricular approach, with a benign evolution, rarely life-threatning. However, spontaneous pneumoventricle is a rare condition, almost always secondary to cerebrospinal fluid (CSF) leakage, with possible worse evolution. We describe a 57-year-old woman, previously healthy, submitted 7 months ago to a bariatric surgery, losing 110 pounds (50 Kg) since that, who developed 1 month ago headache, hemiparesis and incontinence, secondary to a spontaneous pneumoventricle. (au)
O pneumoventrículo é um evento comum no pós-operatório de cirurgias de fossa posterior, ou acessos transventriculares, com uma evolução benigna, raramente letal. Já o pneumoventrículo espontâneo é uma condição rara, quase sempre associado com fístula liquórica, com possível pior prognóstico. Neste trabalho descrevemos uma mulher de 57 anos, previamente hígida, submetida há 7 meses a uma cirurgia bariátrica, perdendo 50 Kg desde então, que há 1 mês apresentou cefaléia, hemiparesia e incontinência vesical, secundárias a um pneumoventrículo espontâneo.
Subject(s)
Humans , Female , Middle Aged , Bariatric Surgery/adverse effects , Pneumocephalus/surgery , Pneumocephalus/etiology , Headache , Meningocele , Pneumocephalus/diagnosis , Paresis , Urinary IncontinenceABSTRACT
Pneumocephalus, characterized by the presence of air in the cranium is frequently caused by trauma and surgery. Meningitis is a very rare cause of pneumocephalus. Here we report a patient who had meningitis as a cause for his pneumocephalus. This patient was diagnosed to have pneumocephalus on CT scan study and was treated with antibiotics to which he responded well, and the repeat CT scan done after two weeks showed normal study.
Subject(s)
Adult , Anti-Bacterial Agents/therapeutic use , Humans , Male , Meningitis/complications , Pneumocephalus/diagnosis , Tomography, X-Ray ComputedABSTRACT
Se presentaron 4 pacientes con neumoencéfalos grandes, 2 de estos a tensión. En 3 casos secundarios a traumatismos: 2 por accidentes de tránsito y 1 como complicación de la evacuación de un higroma. El cuarto enfermo posterior a una inmersión en el mar. El diagnóstico fue realizado por medio de radiografías de cráneo y tomografía computadorizada. Dos pacientes fueron manejados conservadoramente. Un tercer caso después de habérsele evacuado un higroma subdural a tensión empeora neurológicamente por la existencia de un neumoencéfalo bifrontal, y es tratado con doble sistema de sondas subdurales y control de la presión intracraneal, con evolución favorable. El cuarto paciente con gran deterioro neurológico, se le realizó una craneotomía unilateral, por la sospecha de posible fístula dural basal, este paciente después de una mejoría neurológica fallece por complicaciones respiratorias. Se plantean argumentos sobre la fisiología intracraneal del neumoencéfalo manejados por otros autores y se exponen nuestras opiniones
Subject(s)
Pneumocephalus/diagnosis , Neurosurgical ProceduresABSTRACT
Intracranial air is a radiographic finding not uncommon in head-injured patients. It is a relatively benign complication which usually resolves spontaneously. However, under unclear mechanism, tension pneumocephalus (the entrapment of intracranial air under pressure) may be formed and cause neurological symptoms. Five cases of patients with subdural tension pneumocephalus following head injury were reported. All had a basal skull fracture involving the paranasal sinuses or mastoid air cells with coexisting cerebrospinal fluid leakage. The patients showed symptoms and signs of increased intracranial pressure and compression on frontal lobes. Characteristic computerized tomographic findings were noted. Four patients clinically improved with conservative strategy. Only 1 case needed operative correction.
Subject(s)
Adolescent , Adult , Brain/diagnostic imaging , Female , Humans , Male , Middle Aged , Pneumocephalus/diagnosis , Tomography, X-Ray ComputedABSTRACT
Descrevem-se três casos de pneumocéfalo intraparenquimatoso traumático encontrados no decorrer de 20 anos. Os três pacientes, do sexo masculino, tiveram lesäo traumática do andar anterior do crânio, com presença de liquorréia e desenvolvimento de pneumocéfalo diagnosticados de 30 a 60 dias após o trauma. Um dos pacientes desenvolveu uma hemiparesia direita de instalaçäo súbita, o outro apresentou sinais de hipertensäo intracraniana ao lado de alteraçäo mental e ataxia da marcha, e o último apresentava cefaléias que pioravam com as mudanças de posiçäo da cabeça. Em dois deles o diagnóstico foi feito através do RX simples do crânio e no outro pela tomografia computadorizada. Os três pacientes foram operados com esvaziamento do ar e fechamento da fístula na base do crânio. A revisäo da literatura mostrou que esta ocorrência é relativamente rara