Atraumatic pneumocephalus: a case report and review of the literature.

Pneumocephalus or air within the cranial vault is usually associated with disruption of the skull caused by head trauma, neoplasms, or after craniofacial surgical interventions. We report a child who presented with headache and the pathognomonic "succussion splash" and was found to have atraumatic pneumocephalus from forceful valsalva maneuvers. Pneumocephalus forms, caused by either a ball-valve mechanism that allows air to enter but not exit the cranial vault, or cerebrospinal fluid (CSF) leaks, which create a negative pressure with subsequent air entry. We review the literature for traumatic and atraumatic causes of pneumocephalus, its complications, and therapy.

Management of incomplete spontaneous abortion with suction curettage in the pediatric emergency department.

Pregnancy complications, including spontaneous abortion, are increasingly common reasons for teenage girls to seek medical care in pediatric emergency departments (EDs). A protocol was implemented in our department to identify patients with spontaneous abortion who would be candidates for outpatient management. We describe three cases of spontaneous abortion managed with suction curettage in our pediatric ED in collaboration with our obstetric/gynecologic colleagues. There are no reports in the pediatric literature regarding the role of suction curettage in the pediatric ED.

PIP: Recent growth in the pregnancy rate among US adolescents 15-19 years of age has been accompanied by increases in the numbers of teenage girls who present to pediatric emergency departments with pregnancy complications and failures. Financial and utilization factors produce incentives for the management of these patients on an outpatient basis. The pediatric emergency medicine and obstetrics/gynecology departments at Boston (Massachusetts) Medical Center developed a protocol to identify potential candidates for suction curettage in the management of incomplete abortion as an outpatient procedure. This article presents three cases of teens managed under this new protocol. These patients received a paracervical block and/or conscious sedation and underwent dilatation and evacuation without complications; they were discharged 4-7 hours after the procedure. Emotional support and information about the implications of spontaneous abortion for future pregnancy are essential program components. Typically, the procedure costs US$100-150 plus physician fees and laboratory and equipment expenses.