Post-traumatic Tension Pneumoventricle: Case Report

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.

Retroclival Pneumocephalus Associated with Bilateral Abducens Palsy in a Child.

Traumatic brain injury (TBI) is less common in children than in adults. Posterior fossa lesions are even more uncommon, but, when present, are usually epidural hematomas. These lesions, even when small, may have a bad outcome because of the possibility of compression of the important structures that the infratentorial compartment contains, such as the brainstem and cranial nerves, and the constriction of the fourth ventricle, causing acute hydrocephalus. Although unusual, posterior fossa lesions are increasingly being diagnosed because of the better quality of and easier access to cranial tomography. In this paper, we report a case of a 12-year-old male patient who had suffered a TBI and presented with several pneumocephali, one of them in the retroclival region, causing a mass effect and then compression of the sixth cranial nerve which is the most susceptible to these injuries. We discuss these traumatic posterior fossa lesions, with an emphasis on retroclival pneumocephalus, not yet described in the literature in association with bilateral abducens palsy. In addition, we discuss associated lesions and the trauma mechanism.

A rare association of tension pneumocephalus and a large frontoethmoidal osteoma: imaging features and surgical treatment.

Osteomas are the most common benign paranasal sinus tumors and are often found in the frontal and ethmoidal sinus. Intracranial complications such as pneumocephalus have occasionally been reported in association with osteomas. We describe a 33-year-old man with a large frontoethmoidal osteoma complicated by tension pneumocephalus and neurological disturbances, and we discuss the clinical and imaging resolutions after surgical management. We emphasize the imaging features and neuroendoscopic approach to avoid life-threatening conditions.

Spontaneous pneumoventricle following bariatric surgery: case report and review of literature

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.

Presentación de 4 casos con neumoencéfalo / Report of 4 cases with pneumocephalus

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

Pneumocéfalo intraparenquimatoso traumático / Traumatic pneumocephalus intraparenquimatous

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