ABSTRACT
Skull defects and even meningeal defects are responsible for the majority of pneumocephalus cases. Sometimes, several factors can produce intracranial gas under pressure (tension pneumocephalus) with severe neurological impairment. We present a case of a 66 year old woman with a double ventriculo-peritoneal shunt that was admitted to the emergency service with an intracranial hypertension syndrome. A scalp wound was found on the physical examination and a brain CT showed a tension pneumocephalus. The scalp wound was just located on the border of a cranioplasty made after surgical removal of a parasagital meningioma eight years ago. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and modification of factors contributing to the tension pneumocephalus (ventricular-peritoneal shunts programmed to low pressure) were performed. When we found a patient with a tension pneumocephalus we must think not only about a skull or meningeal defect but also look for other elements that produce gas inside skull under pressure (shunts, cerebrospinal fluid leak between others). Therefore, therapeutic approach has three parts: pneumocephalus drainage, to find and repair entrance of gas and to modify factors that turn pneumocephalus in a tension pneumocephalus.
Subject(s)
Head Injuries, Closed/complications , Pneumocephalus/etiology , Scalp/injuries , Ventriculoperitoneal Shunt/adverse effects , Aged , Female , Head Injuries, Closed/pathology , HumansABSTRACT
El neumoencéfalo se produce la mayoría de lasveces por una solución de continuidad en el cráneo eincluso en las meninges. En ocasiones, ciertos factorespueden hacer que éste adopte las características deun neumoencéfalo a tensión provocando una clínicaneurológica severa. Presentamos el caso de una pacientede 66 años portadora de una doble válvula de derivaciónventrículo-peritoneal que acude a Urgencias con uncuadro de hipertensión intracraneal y que tras la exploraciónfísica y la tomografía computarizada se detectauna herida en cuero cabelludo y un neumoencéfalo atensión. Este defecto en piel se hallaba justo en la zonadel borde de una plastia craneal colocada tras la resecciónde un meningoma parasagital 8 años antes. Se realizódrenaje, reparación de la solución de continuidady modificación de los factores que agravaban el cuadrodel neumoencéfalo (la presencia de unas válvulas dederivación con presiones de salida muy bajas).La presencia de un neumoencéfalo a tensión debehacernos pensar en encontrar no sólo el punto deacceso del aire al interior del cráneo sino también lascausas que han favorecido que el neumoencéfalo adoptecaracterísticas de alta presión (sistemas de derivacióno fístulas de LCR entre otros). De esta forma la orientaciónterapéutica adecuada tiene que ir destinada a lamodificación de estos factores agravantes, además dehacia el drenaje del neumoencéfalo y cierre del defectocraneal (AU)
Skull defects and even meningeal defects are responsiblefor the majority of pneumocephalus cases.Sometimes, several factors can produce intracranialgas under pressure (tension pneumocephalus) withsevere neurological impairment. We present a case of a66 year old woman with a double ventriculo-peritonealshunt that was admitted to the emergency service withan intracranial hypertension syndrome. A scalp woundwas found on the physical examination and a brain CTshowed a tension pneumocephalus. The scalp woundwas just located on the border of a cranioplasty madeafter surgical removal of a parasagital meningiomaeight years ago. Evacuation of pneumocephalus, reparationof cranial and meningeal defects and modificationof factors contributing to the tension pneumocephalus(ventricular-peritoneal shunts programmed to lowpressure) were performed.When we found a patient with a tension pneumocephaluswe must think not only about a skull or meningealdefect but also look for other elements that producegas inside skull under pressure (shunts, cerebrospinalfluid leak between others). Therefore, therapeuticapproach has three parts: pneumocephalus drainage,to find and repair entrance of gas and to modify factorsthat turn pneumocephalus in a tension pneumocephalus (AU)
