RESUMO
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.
Assuntos
Humanos , Pneumocefalia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Hipertensão Intracraniana/diagnóstico por imagemRESUMO
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.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/cirurgia , Fístula/líquido cefalorraquidiano , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias , Imageamento por Ressonância Magnética/métodos , Tomografia por Raios X/métodosRESUMO
PURPOSE: To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.
Assuntos
Pré-Escolar , Feminino , Humanos , Doenças do Nervo Abducente , Acidentes de Trânsito , Encéfalo , Fraturas Múltiplas , Mãos , Imageamento por Ressonância Magnética , Oftalmoplegia , Nervo Óptico , Órbita , Pneumocefalia , Pupila , Retina , Oclusão da Artéria Retiniana , Artéria Retiniana , Hemorragia Retiniana , Veia Retiniana , Vasos Retinianos , Retinaldeído , Crânio , Veias , Acuidade VisualRESUMO
Epiduroscopy is defined as a percutaneous, minimally invasive endoscopic investigation of the epidural space. Periduroscopy is currently used mainly as a diagnostic tool to directly visualize epidural adhesions in patients with failed back surgery syndrome (FBSS), and as a therapeutic action in patients with low back pain by accurately administering drugs, releasing inflammation, washing the epidural space, and mechanically releasing the scars displayed. Considering epiduroscopy a minimally invasive technique should not lead to underestimating its potential complications. The purpose of this review is to summarize and explain the mechanisms of the side effects strictly related to the technique itself, leaving aside complications considered typical for any kind of extradural procedure (e.g. adverse reactions due to the administration of drugs or bleeding) and not fitting the usual concept of epiduroscopy for which the data on its real usefulness are still lacking. The most frequent complications and side effects of epiduroscopy can be summarized as non-persistent post-procedural low back and/or leg discomfort/pain, transient neurological symptoms (headache, hearing impairment, paresthesia), dural puncture with or without post dural puncture headache (PDPH), post-procedural visual impairment with retinal hemorrhage, encephalopathy resulting in rhabdomyolysis due to a dural tear, intradural cyst, as well as neurogenic bladder and seizures. We also report for first time, to our knowledge, a case of symptomatic pneumocephalus after epiduroscopy, and try to explain the reason for this event and the precautions to avoid this complication.
Assuntos
Humanos , Encefalopatias , Cicatriz , Espaço Epidural , Síndrome Pós-Laminectomia , Perda Auditiva , Inflamação , Perna (Membro) , Dor Lombar , Parestesia , Preparações Farmacêuticas , Pneumocefalia , Cefaleia Pós-Punção Dural , Punções , Hemorragia Retiniana , Rabdomiólise , Convulsões , Lágrimas , Aderências Teciduais , Bexiga Urinaria Neurogênica , Transtornos da VisãoRESUMO
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.
Assuntos
Idoso , Feminino , Humanos , Anestesia e Analgesia , Anestesia Epidural , Dor nas Costas , Líquido Cefalorraquidiano , Dor Crônica , Tontura , Orelha Interna , Fístula , Audição , Perda Auditiva , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Pressão Intracraniana , Bloqueio Nervoso , Perilinfa , Pneumocefalia , VertigemRESUMO
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.
Assuntos
Humanos , Vazamento de Líquido Cefalorraquidiano , Líquido Cefalorraquidiano , Seio Etmoidal , Seio Frontal , Cefaleia , Mucocele , PneumocefaliaRESUMO
Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.
Assuntos
Humanos , Vazamento de Líquido Cefalorraquidiano , Rinorreia de Líquido Cefalorraquidiano , Líquido Cefalorraquidiano , Diabetes Insípido , Orelha , Obstrução Nasal , Nariz , Seios Paranasais , Faringe , Pneumocefalia , Rinoplastia , Base do Crânio , Seio EsfenoidalRESUMO
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.
Assuntos
Humanos , Masculino , Adulto , Pneumocefalia/etiologia , Traumatismos Craniocerebrais/complicações , Pneumocefalia/cirurgia , Pneumocefalia/diagnóstico , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal , Vazamento de Líquido Cefalorraquidiano/cirurgia , Vazamento de Líquido Cefalorraquidiano/etiologiaRESUMO
The advent of neuroimaging like computed tomography and magnetic resonance imaging has facilitated the diagnosis of traumatic brain injuries. Emphasizing certain diagnostic features of some peculiar traumatic brain injuries. The following lesions of traumatic brain injuries were pictorially depicted, namely Tension pneumocephalus, Blow out orbit, Bilateral subacute subdural haematomata, Acute-onchronic subdural haematoma, Middle cranial fossa acute epidural haematoma, Traumatic basal ganglial haematoma and Acute intra-ventricular haematoma. Mount Fuji sign is typical of tension pneumocephalus while herniation of extra-ocular muscles into the maxillary sinus is diagnostic of blowout orbit. Rabbit ear appearance is observable in bilateral subacute subdural haematomata
Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Imageamento por Ressonância Magnética , Nigéria , PneumocefaliaRESUMO
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.
Assuntos
Humanos , Feminino , Adulto , Pneumocefalia/complicações , Empiema Subdural/cirurgia , Encefalopatias/etiologia , Drenagem , Hérnia/etiologia , Complicações Intraoperatórias/etiologia , Índice de Gravidade de DoençaRESUMO
Introduction Intraspinal gas is a common clinical finding, but an epidural gas pseudocyst in association with lateral disc herniation compressing a nerve root is an exceptional observation. Case Report A 49-year-old man was admitted to our department presenting with sciatica. The neurological examination demonstrated moderate lumbar pain without neurological deficit. A lumbosacral computed tomography showed the presence of degenerated disc herniation and epidural gas collection. Discussion The pathological association between the cyst and the hernia is probably due to the migration of gas pumped from the intervertebral space through a breaking point or lower in the annulus fibrosis, involving its contiguity with the herniated disc. Conclusion An association between a disc herniation and a gas pseudocyst can be a cause of sciatica.
Introdução O gás intraespinal é um achado clínico comum, mas um pseudocisto epidural de gás associado a herniação discal lateral comprimindo uma raiz nervosa é uma observação excepcional. Relato de caso Um homem de 49 anos de idade foi admitido em nosso departamento apresentando sintomas de ciática. O exame neurológico demonstrou dor lombar moderada sem déficit neurológico. A tomografia computadorizada lombossacral mostrou presença de hérnia discal degenerada e coleta epidural de gás. Discussão A associação patológica entre o cisto e a hérnia é provavelmente devida à migração do gás bombeado do espaço intervertebral através de um ponto de ruptura ou menor na fibrose do anel, envolvendo a sua contiguidade com o disco herniado. Conclusão Uma associação entre uma hérnia de disco e um pseudocisto de gás pode ser uma das causas de ciática.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia , Deslocamento do Disco Intervertebral , CiáticaRESUMO
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.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Encéfalo , Cefaleia , Injeções Epidurais , Mioclonia , Pneumocefalia , VômitoRESUMO
The authors describe a case of pneumocephalus following epidural anaesthesia for total knee arthroplasty. Multiple attempts in locating the epidural space for the anaesthesia and the use of loss of resistance to air (LORA) technique were identified as the source of air entry. Supportive management was given including high flow oxygenation therapy and spontaneous reabsorption of air was noted five days after surgery. The presence of pneumocephalus should be kept in mind if patient develops neurological complications postoperatively following epidural anaesthesia.
Assuntos
Pneumocefalia , Anestesia em Procedimentos CardíacosRESUMO
A 45-year-old woman was admitted due to severe headache and neck stiffness. She had visited a local clinic for back pain and received a lumbar nerve root steroid injection 10 days before admission. Computed tomography and magnetic resonance imaging showed psoas abscess, pneumocephalus, and subdural hygroma. She was diagnosed with psoas abscess and meningitis. The abscess and external ventricle were drained, and antibiotics were administered. Unfortunately, the patient died on hospital day 19 due to diffuse leptomeningitis. Lumbar nerve root steroid injections are commonly used to control back pain. Vigilance to "red flag signs" and a rapid diagnosis can prevent lethal outcomes produced by rare and unexpected complications related to infection. Here, we report a case of fatal meningitis after infection of the cerebrospinal fluid following a lumbar nerve root steroid injection.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Abscesso , Antibacterianos , Dor nas Costas , Líquido Cefalorraquidiano , Diagnóstico , Cefaleia , Imageamento por Ressonância Magnética , Meningite , Pescoço , Pneumocefalia , Abscesso do Psoas , Derrame SubduralRESUMO
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.
Assuntos
Adulto , Humanos , Masculino , Repouso em Cama , Cefaleia , Náusea , Oxigênio , Pneumocefalia , Neoplasias da Medula Espinal , Coluna Vertebral , Coxa da Perna , Tomografia Computadorizada por Raios X , VômitoRESUMO
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.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Líquido Cefalorraquidiano , Vazamento de Líquido Cefalorraquidiano , Tosse , Traumatismos Craniocerebrais , Emergências , Serviço Hospitalar de Emergência , Meningite , Nasofaringe , Pneumocefalia , Convulsões , EstuporRESUMO
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.