Neumoencéfalo en la paciente puérpera una complicación de la anestesia peridural

Introducción: La utilidad de las técnicas de anestesia regional se ha mostrado por muchos años, estas son las de elección por los beneficios que aporta, como es el caso de la cesárea, aunque no están exentas de complicaciones, y las neurológicas que son las más temidas por la gravedad del cuadro clínico presentado y los posibles desenlaces. Objetivo: Describir la evolución clínica de la puérpera con diagnóstico de neumoencéfalo después de anestesia neuroaxial peridural. Presentación de caso: Se trata de una paciente puérpera con antecedente de cefalea migrañosa que después de ser sometida a una anestesia peridural, comienza con dolor de cabeza ligero a moderado que en un principio aliviaba con analgésicos, después hace una convulsión tónica clónico generalizada que fue necesaria intubar y trasladar a terapia intensiva. Mediante la tomografía axial computarizada se detecta neumoencéfalo de pequeñas proporciones en región parietal, además, de signos de edema cerebral, el cuadro evoluciona satisfactoriamente, la paciente a las horas es trasladad a sala donde se reencuentra con su bebe y días después es dada de alta sin secuelas. Conclusiones: El neumoencéfalo como complicación de la anestesia peridural en la paciente gestante, generalmente no tienen gran repercusión clínica y desaparece solo en un período no mayor de 72 horas, pero en ocasiones puede presentarse como complicación grave que puede acarrear daño neurológico permanente e incluso la muerte.

Introduction: Regional anesthesia techniques have been used for many years and there are surgeries where they are the ones of choice due to the proven benefits they provide, as is the case with anesthesia forces is a section, which is not free of complications, but the neurological ones are the ones. Most feared, due to the complexity of the situation and the possible outcomes they could entail. Objective: To describe the evolution of a postpartum patient who was diagnosed with Pneumocephalus after epidural anesthesia. Clinical case: Postpartum patient with a history of migraine headache, which after undergoing epidural anesthesia, began with light to moderate headache that was initially relieved with analgesics, then had a generalized tonic-clonic seizure that required intubation and transfer to the intensive therapy. Using computed axial tomography, small Pneumocephalus was detected in the parietal region in addition to signs of cerebral edema. The condition progressed satisfactorily. Within hours, the patient was transferred to the ward where she was reunited with her baby and day slater she was discharged without squeals. Conclusions: Pneumocephalus as a complication of epidural anesthesia in pregnant patients generally does not have great clinical repercussions and disappears only in a period of no more than 72 hours, but sometime sit can occur as a serious complication that can lead to permanent neurological damage and even death, death.

Neumoencéfalo como complicación de bloqueo regional epidural por radiculopatía lumbosacra / Pneumocephalus as a Complication of Regional Epidural Block Due to Lumbosacral Radiculopathy

Introducción: El neumoencéfalo (sinonimia: aerocele o neumatocele intracerebral), se define como la presencia de gas dentro de cualquiera de los compartimentos intracraneales (intraventricular, intraparenquimatosa, subaracnoidea, subdural y epidural). Objetivo: Describir los hallazgos clínicos, estudios complementarios, conducta terapéutica y evolución de un caso con neumoencéfalo como complicación de bloqueo regional epidural por radiculopatía lumbosacra. Presentación de caso: Se presentó un paciente masculino de 57 años de edad que comenzó con un cuadro súbito de desorientación, excitabilidad psicomotriz y convulsiones tónico-clónicas, a partir de una inyección epidural de metilprednisolona como método analgésico. Conclusiones: El caso presentado exhibió manifestaciones neurológicas inespecíficas, la aparición súbita posterior al proceder invasivo hizo sospechar en un evento neurológico agudo o fenómeno tromboembólico. Los estudios complementarios como la tomografía axial computarizada craneal simple, permitió su diagnóstico para tener una conducta consecuente. El manejo conservador del neumoencéfalo como complicación del uso de anestesia epidural, constituyó una conducta terapéutica eficaz y repercutió en la satisfactoria evolución del paciente(AU)

Introduction: Pneumocephalus (synonym: aerocele or intracerebral pneumatocele), is defined as the presence of gas within any of the intracranial compartments (intraventricular, intraparenchymal, subarachnoid, subdural and epidural). Objective: To describe the clinical findings, complementary studies, therapeutic conduct and evolution of a case with pneumocephalus as a complication of regional epidural block due to lumbosacral radiculopathy Case presentation: A 57-year-old male patient was presented who began with a sudden episode of disorientation, psychomotor excitability and tonic-clonic seizures, following an epidural injection of methylprednisolone as an analgesic method. Conclusions: The case presented exhibited non-specific neurological manifestations, the sudden appearance after the invasive procedure raised suspicion of an acute neurological event or thromboembolic phenomenon. Complementary studies such as simple cranial computed axial tomography, allowed its diagnosis to have a consistent conduct. The conservative management of pneumocephalus as a complication of the use of epidural anesthesia constituted an effective therapeutic approach and had an impact on the patient's satisfactory evolution(AU)

Neumoencéfalo, una revisión de literatura / Pneumocephalus, a literature review

El neumoencéfalo corresponde a la presencia de aire intracraneal y, en general, es asintomático y autolimitado. Puede ocurrir posterior a trauma, cirugía craneofacial, defectos congénitos, infección, neoplasia o de forma espontánea. El neumoencéfalo a tensión es una emergencia neuroquirúrgica, en la que se acumula aire intracraneal de forma continua que genera un efecto de masa. Clínicamente, se caracteriza por cefalea y un deterioro neurológico marcado. A pesar de ser poco frecuente, es relevante considerar el neumoencéfalo a tensión como una posible complicación en pacientes con antecedente de neurocirugía y/o cirugía otorrinolaringológica, debido a que es una patología potencialmente grave. El diagnóstico es clínico e imagenológico, y requiere de un alto índice de sospecha. Un manejo oportuno es relevante para prevenir la herniación y la muerte.

Pneumocephalus refers to the presence of air in the cranial cavity, and in general, is self-limited and asymptomatic. It can occur after trauma, craniofacial surgery, due to congenital defects, infection, neoplasia or spontaneously. Tension pneumocephalus is a neurosurgical emergency in which intracranial air accumulates continuously, causing a mass effect. It presents with headache and marked neurological deterioration. Despite being rare, it is relevant to consider tension pneumocephalus as a possible complication in patients with a history of neurosurgery and/or otolaryngology surgery, as it can be life-threatening. Diagnosis requires a high index of suspicion and imagenologic confirmation. Timely management is relevant to prevent herniation and death.

Neumoencéfalo recurrente post quirúrgico, a raíz de dos casos / Post-surgical late pneumoencephalus, based on two cases

El neumoencéfalo es una patología que comúnmente se presenta después de cirugía neuroquirúrgica y ocasionalmente endonasal. Estos se suelen manejar de manera conservadora, sin embargo, se pueden asociar a distintas etiologías las cuales los hacen recurrir. En este reporte presentamos dos casos de neumoencéfalo tardío post quirúrgico asociado a fístulas de LCR de bajo flujo, donde se discute su clínica, etiología y manejo posterior.

Pneumocephalus is a pathology that commonly occurs after endonasal surgery, these are usually managed conservatively, however they can be associated with different etiologies which make them recur. In this report we present two cases of post-surgical late pneumocephalus associated with low-flow CSF fistulae, where its symptoms, etiology, and subsequent management are discussed.

TRAUMATIC PNEUMOCEPHALUS : AIR REPLACEMENT PROCEDURE VS CONTROLLED DECOMPRESSION WITH EXTERNAL DRAINAGE

Introduction: Air within cranium may be classified according to the site of occurrence. The pathophysiology of the same is varied and the effects are manifold. Methods: Patients with tension pneumocephalus are taken up for surgery.Results: In controlled decompression group, the pain requirement and duration of hospital stay was more. The air replacement procedure group had more recollection and one patient required a second procedure.Conclusion: Most of the cases subside with normobaric 100% oxygen therapy. In patients with persistent pneumocephalus for more than two weeks, more definitive procedures for sealing of the dural rent may be required

Factors affecting outcomes in compound depressed frontal bone fractures: Institutional study

xIntroduction: Compound depressed frontal bone fractures exhibits some peculiarities such as frequent involvement of frontal sinus and olfactory nerve and tract, which lie on the floor of the anterior cranial fossa. The primary aim of our study is analyzing factors influencing the outcomes in compound depressed fractures of frontal bone .This will help in improving outcomes and management of compound depressed frontal bone fracture. Material and methods: Study was conducted at tertiary care institute by collecting data of 40 patients operated surgically from August 2018 to July 2019. The study included patients who were diagnosed with compound depressed frontal bone fracture and underwent surgical management at our institute. Follow-up was performed at least 3 months after the trauma. The variables evaluated were mortality, GOS, occurrence of rhinorrhea, meningitis, late post-traumatic epilepsy and smell disturbances. Results: Most of our patient with GCS 13-15 was discharged with good clinical outcome and no complication on follow-up. Patient with low GCS and delayed presentation are at risk and adds up morbidity and mortality. Conclusion: Early surgical intervention in patients with GCS 13-15 is associated with good outcomes and low complication rate associated with meningitis or CSF leak.

Comparison of the effects of bilateral and non-bilateral frontal pneumocephalus on acute agitation after craniotomy for brain tumor / 中国医师进修杂志

Objective To compare the effects of bilateral and non- bilateral frontal pneumocephalus on acute agitation after craniotomy for brain tumor. Methods The clinical data of 406 brain tumor patients who had underwent craniotomy in Maoming Traditional Chinese Medicine Hospital and Guangdong Provincial People′s Hospital from January 2014 to January 2019 were retrospectively analyzed. The patients were divided into bilateral frontal pneumocephalus group (92 cases) and unilateral frontal pneumocephalus group (314 cases) according to frontal pneumocephalus within 12 hours after operation. Within 24 hours after operation, the sedation-agitation scale (SAS) was evaluated, and SAS≥ 5 scores was defined as acute agitation. Results The incidence of postoperative acute agitation, rate of postoperative sedatives use and postoperative hospital stay in bilateral frontal pneumocephalus group were significantly higher than those in unilateral frontal pneumocephalus group: 23.9% (22/92) vs. 8.6% (27/314), 14.1% (13/92) vs. 3.5% (11/314) and (12.2 ± 2.6) d vs. (8.5 ± 1.6) d, and there were statistical differences (P＜0.01 or ＜0.05). Conclusions Brain tumor patients who had bilateral frontal pneumocephalus after craniotomy are more likely to develop acute agitation.

Pneumoncoccal Meningitis Presenting with Ventriculitis and Pneumocephalus

No abstract available.

Fístula Liquórica Esfenoidal Espontânea ­ relato de caso / Spontaneous sphenoidal liquor fistula - Case report

Introdução: fístula liquórica rinogênica é uma comunicação do espaço subaracnóideo com a fossa nasal ou seios paranasais, decorrentes a um defeito anatômico da dura-máter, osso e mucosa. As fístulas liquóricas nasais espontâneas são eventos raros, cerca de 3%, com possíveis complicações deletérias e uma causa definida. Relato de caso: o caso relatado é de paciente de 47 anos, com queixa de cefaleia de forte intensidade, diagnosticado com fístula liquórica esfenoidal espontânea. Conclusão: o otorrinolaringologista tem importante papel em realizar o diagnóstico e assistir o paciente com fístula liquórica rinogênica.

Introduction: rhinoid cerebrospinal fluid fistula is a communication of the subarachnoid space with the nasal fossa or paranasal sinuses, due to an anatomical defect of the dura mater, bone and mucosa. Spontaneous nasal fluid fistulas are rare events, about 3%, with possible deleterious complications and a definite cause. Case report: the case reported is a 47-year-old patient complaining of severe headache, diagnosed with spontaneous sphenoidal cerebrospinal fluid fistula. Conclusion: has an important role in the diagnosis and assistance of cases with rhinoid cerebrospinal fluid fistula.

A Case of Frontoethmoidal Mucopyocele Combined with Cerebrospinal Fluid Leak and Complicated Tension Pneumocephalus after Marsupialization

After the trauma of frontoethmoidal sinus, post-traumatic mucocele may occur. Surgical removal of the lesions rarely produces cerebrospinal fluid (CSF) leakage and even delayed tension pneumocephalus. We experienced a case of fronto-ethmoid mucocele complicated with peri-operative CSF leakage and post-operative tension pneumocephalus which was improved by conservative treatment. It is imperative to take into account the potential for tension pneumocephalus when a patient suffers from severe headache after sinus surgery.

Pneumocephalus caused by congenital mastoid dysplasia:A case report and literature review / 吉林大学学报(医学版)

Objective:To investigate the diagnosis and treatment of one patient with pneumocephalus caused by congenital mastoid dysplasia,and to clarify the clinical features,diagnostic methods and treatment strategies of intracranial accumulation of pneumocephalus.Methods:The patient with ineffective right upper limb activity accompanied stupid speech for 12 h was admitted to hospital.After admission,the head CT and MRI examination were performed again,and the patient was diagnosed as pneumocephalus.The paitent scheduled for stoma repair,neurotrophic treatment,infection prevention and other symptomatic treatments were performed after operation;the patient was instructed avoid cough forcefully,blowing nose,defecating and sneezing to increase the intracranial pressure.Results:Due to congenital dysplasia of mastoid wall,local thinning bones and intense swimming choking cough of the patient destroyed the intracranial pressure balance to form pneumocephalus,the patient scheduled for stoma and damaged dura repair;when discharged from hospital,the patient's right upper limb muscle strength and language function returned to normal;the head CT results showed that pneumocephalus disappeared completely.Conclusion;Pneumocephalus is common in clinic,and its reason is diversiform;it should be combined with the patient's history and imaging findings to explore the causes,the most reasonable treatment measures should be performed in order to relieve the patient's symptoms of increased intracranial pressure,and promote the recovery of neural function.

A Case of Sensorineural Hearing Loss and Vertigo during Epidural Nerve Block / 대한평형의학회지

Epidural anesthesia has significantly advanced in neuraxial anesthesia and analgesia. It is used for surgical anaesthesia and treatment of chronic pain. Hearing loss during or after epidural anesthesia is rare, and it is known to occur by the change of the intracranial pressure. Cerebrospinal fluid is connected with perilymph in the cochlear and vestibule that is important to hearing and balance. If the intracranial pressure is abruptly transferred to the inner ear, perilymph can be leak, that called perilymphatic fistula, dizziness, and hearing loss can occur suddenly. We report a 65-year-old woman who presented with acute onset dizziness and hearing loss during the epidural nerve block for back pain, wherein we speculated a possibility of perilymphatic fistula as the mechanism of hearing loss and dizziness. The mechanism of dizziness and hearing loss was suspected with perilymphatic fistula.

Pneumocephalus caused by congenital mastoid dysplasia: A case report and literature review / 吉林大学学报(医学版)

Objective: To investigate the diagnosis and treatment of one patient with pneumocephalus caused by congenital mastoid dysplasia, and to clarify the clinical features, diagnostic methods and treatment strategies of intracranial accumulation of pneumocephalus. Methods: The patient with ineffective right upper limb activity accompanied stupid speech for 12 h was admitted to hospital. After admission, the head CT and MRI examination were performed again, and the patient was diagnosed as pneumocephalus. The paitent scheduled for stoma repair, neurotrophic treatment, infection prevention and other symptomatic treatments were performed after operation; the patient was instructed avoid cough forcefully, blowing nose, defecating and sneezing to increase the intracranial pressure. Results: Due to congenital dysplasia of mastoid wall, local thinning bones and intense swimming choking cough of the patient destroyed the intracranial pressure balance to form pneumocephalus, the patient scheduled for stoma and damaged dura repair; when discharged from hospital, the patient's right upper limb muscle strength and language function returned to normal; the head CT results showed that pneumocephalus disappeared completely. Conclusion: Pneumocephalus is common in clinic, and its reason is diversiform; it should be combined with the patient's history and imaging findings to explore the causes, the most reasonable treatment measures should be performed in order to relieve the patient's symptoms of increased intracranial pressure, and promote the recovery of neural function.

Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema / Herniação cerebral intratável secundária a pneumoencéfalo hipertensivo no intraoperatório: uma complicação rara com risco para a vida durante a drenagem de empiema subdural

Abstract Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.

Resumo O pneumoencéfalo hipertensivo é raro, mas foi bem documentado após trauma e procedimentos neurocirúrgicos. Trata-se de uma emergência cirúrgica porque pode levar à deterioração neurológica, herniação do tronco cerebral e morte. Ao contrário de casos anteriores, nos quais o pneumoencéfalo hipertensivo se desenvolveu no pós-operatório, descrevemos um caso de pneumoencéfalo hipertensivo desenvolvido no período intraoperatório que levou a uma herniação cerebral súbita, maciça e aberta para fora do local da craniotomia. Os possíveis fatores causais são destacados. É imperativo identificar rapidamente as possíveis causas da herniação cerebral aguda no intraoperatório, incluindo o pneumoencéfalo hipertensivo, e instituir medidas apropriadas para minimizar os danos neurológicos.

Proper Management of Posttraumatic Tension Pneumocephalus / 대한신경손상학회지

Pneumocephalus is commonly seen after craniofacial injury. The pathogenesis of pneumocephalus has been debated as to whether it was caused by ball valve effect or combined episodic increased pressure within the nasopharynx on coughing. Discontinuous exchange of air and cerebrospinal fluid due to “inverted bottle” effect is assumed to be the cause of it. Delayed tension pneumocephalus is not common, but it requires an active management in order to prevent serious complication. We represent a clinical case of a 57-year-old male patient who fell down from 3 m height, complicated by tension pneumocephalus on 5 months after trauma. We recommend a surgical intervention, but the patient did not want that so we observe the patient. The patient was underwent seizure and meningitis after 7 months after trauma, he came on emergency room on stupor mentality. Tension pneumocephalus may result in a neurologic disturbance due to continued air entrainment and it significantly the likelihood of intracranial infection caused by continued open channel. Tension pneumocephalus threat a life, so need a neurosurgical emergency surgical intervention.

A Rare Complication of Lumbar Spinal Surgery: Pneumocephalus / 대한신경손상학회지

A 25-year-old male patient with severe thigh and right side pain was presented. In the lumbar magnetic resonance images, there was a contrasting spinal cord tumor image with 1 cm in diameter at the level of the L3 vertebra. The patient was operated and the tumor was totally removed. All the pain of the patient recovered. The patient's postoperative two days were very comfortable and the patient was early mobilized. On the third postoperative day, the patient complained of severe headache, nausea and vomiting. Immediate cranial computed tomography (CT) images was performed. Cerebral pneumocephalus was present in CT. The patient was treated with definite bed rest and plenty of fluid replacement. After three days, the patient's complaints were completely improved. This improvement was confirmed by performing a cerebral CT scan. In the formation of pneumocephalus, air is compressed into the intradural space during operation and this passes to the cerebral space. Definite bed rest, abundant fluid replacement and, in addition, highly inspired oxygen therapy are sufficient to correct the condition.

Pneumocephalus after Interlaminar Lumbar Epidural Block / 대한정형외과학회잡지

Lumbar epidural block using a “loss of resistance” technique (LORT) with air can potentially cause pneumocephalus. Herein, we present a pneumocephalus that occurred after an epidural block. A 58-year-old male patient underwent an interlaminar lumbar epidural block using a LORT with air for L4–5 disc herniation. After the block, the patient complained of headache, vomiting, and truncal myoclonus. For further evaluation, a brain computed tomography was performed, and pneumocephalus was finally diagnosed. The patient underwent conservative treatment and recovered without any complications. He was discharged on the 11th day after the block.

Central hyperventilation syndrome due to massive pneumocephalus after endoscopic third ventriculostomy: a case report / 대한마취과학회지

Pneumocephalus is common after brain surgeries, but usually is not substantial enough to cause serious complications. We recently encountered a case of post-operative tachypnea after an endoscopic 3rd ventriculostomy. At first, we thought that the hyperventilation was the result of residual paralysis after emergence from anesthesia, but during further evaluation we found a massive pneumocephalus. In such unusual post-operative situations, physicians should consider surgery-related complications as the possible cause as well, along with the anesthetic factors.

Extended Pneumocephalus after Drainage of Chronic Subdural Hematoma Associated with Intracranial Hypotension : Case Report with Pathophysiologic Consideration

Chronic subdural hematoma (SDH) is a well-known disease entity and is traditionally managed with surgery. However, when associated with spontaneous intracranial hypotension (SIH), the treatment strategy ought to be modified, as classical treatment could lead to unwanted consequences. A 59-year-old man presented with a case of SIH that manifested as a bilateral chronic SDH. He developed fatal extensive pneumocephalus and SDH re-accumulation as a complication of burr-hole drainage. Despite application of an epidural blood patch, the spinal cerebrospinal fluid leak continued, which required open spinal surgery. Chronic SDH management should not be overlooked, especially if the exact cause has not been determined. When chronic SDH assumed to be associated with SIH, the neurosurgeon should determine the exact cause of SIH in order to effectively correct the cause.

Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

Development of a communication between the spinal subarachnoid space and the pleural space after thoracic spine surgery is uncommon. Subarachnoid pleural fistula (SAPF), a distressing condition, involves cerebrospinal fluid leakage. Here we report an unusual case of SAPF, occurring after thoracic spine surgery, that was further complicated by pneumocephalus and pneumorrhachis postthoracentesis, which was performed for unilateral pleural effusion.