Delayed pneumocephalus induced by repeated percutaneous aspiration after spinal surgery: A case report and literature review.

RATIONALE: Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery. PATIENT CONCERNS: A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16. DIAGNOSIS: Emergency brain computed tomography revealed massive pneumocephalus. INTERVENTIONS: Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol. OUTCOMES: Repeated computed tomography showed complete resolution of the pneumocephalus after five days. LESSONS: Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.

A disease progression prediction model and nervous system symptoms in coronavirus disease 2019 patients.

This study aimed to investigate factors affecting coronavirus disease 2019 (COVID-19) progression, also to explore the clinical features and prognosis of nervous system symptom (NSS) involved COVID-19 patients. 417 COVID-19 patients were analyzed in this retrospective study, and they were clinically classified as severe patients and non-severe patients. According to NSS involved status, COVID-19 patients were further divided into NSS patients and non-NSS patients. Elderly cases, males, common comorbidities, NSS, respiratory/cardiovascular/gastrointestinal symptoms, bilateral lesion, multifocal lesion, bacterial infection, bacterial&fungal infection were more common in severe patients compared to non-severe patients. Meanwhile, severe COVID-19 patients showed increased baseline APTT, TT, D-dimer, CRP, ESR, CK-MB, creatine kinase, AST, ALT, creatinine, but decreased baseline platelet level, lymphocyte, albumin, GFR compared to non-severe patients. Notably, the continuous differences of lymphocyte, D-dimer, CRP, AST, ALT, albumin, GFR between severe patients and non-severe patients during treatment were observed. Age, NSS, bacterial & fungal infection, CRP and creatinine were further identified as independent risk factors for severe COVID-19, which could predict severe COVID-19 with area under curve of 0.861. Furthermore, severe patients presented with worse prognosis. Regrading NSS patients, they were related to older age, surgery history, diabetes comorbidities, respiratory/cardiovascular/gastrointestinal symptoms, bilateral lesion, multifocal lesion, bacterial infection, bacterial&fungal infection and more dysregulated laboratory indexes compared to non-NSS patients. Besides, NSS patients were correlated with poor prognosis to some extent. More intensive attention should be paid to COVID-19 patients with severe-disease risk factors and those with NSS involvement, in case of rapid deterioration.