Assuntos
Analgésicos/efeitos adversos , Injeções Espinhais/efeitos adversos , Deslocamento do Disco Intervertebral/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Ozônio/efeitos adversos , Pneumocefalia/induzido quimicamente , Adulto , Analgésicos/administração & dosagem , Feminino , Humanos , Ozônio/administração & dosagemRESUMO
TITLE: Neumoencefalo a tension intraoperatorio secundario al uso de peroxido de hidrogeno como agente hemostatico.
Assuntos
Hemorragia Cerebral/tratamento farmacológico , Craniotomia , Encefalocele/etiologia , Hematoma/tratamento farmacológico , Hemostasia Cirúrgica/efeitos adversos , Peróxido de Hidrogênio/efeitos adversos , Complicações Intraoperatórias/induzido quimicamente , Pneumocefalia/induzido quimicamente , Idoso , Dano Encefálico Crônico/etiologia , Hemorragia Cerebral/cirurgia , Drenagem , Encefalocele/diagnóstico por imagem , Hematoma/cirurgia , Hemostasia Cirúrgica/métodos , Humanos , Peróxido de Hidrogênio/administração & dosagem , Complicações Intraoperatórias/diagnóstico por imagem , Masculino , Lobo Parietal/cirurgia , Pneumocefalia/complicações , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/terapia , Complicações Pós-Operatórias/etiologia , Irrigação Terapêutica , Tomografia Computadorizada por Raios XRESUMO
Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.
Assuntos
Síndrome Pós-Laminectomia/cirurgia , Cefaleia/induzido quimicamente , Ozônio/efeitos adversos , Pneumocefalia/induzido quimicamente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Pneumocefalia/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
We describe a patient with pneumocephalus following an epidural steroid injection (ESI) who presented with altered mental status, headache, focal neurologic findings and seizures. Pneumocephalus has rarely been described following ESI. A 34-year-old female presented with an altered level of consciousness worsening over approximately 18h following an ESI for lumbar back pain. She had associated headache, right-sided facial twitching and right upper extremity weakness. A brain CT scan revealed pneumocephalus in the right lateral ventricle and quadrigeminal plate cistern. While in the emergency department she experienced a self-limited generalized seizure. She was admitted and her symptoms persisted. Seven days following admission she was discharged to a rehabilitation facility, but her arm weakness persisted for greater than a month before resolving. Epidural anesthesia relies on the localization of the epidural space. The manual loss of resistance technique is widely used to identify the epidural space. The incidence of adverse effects is unknown. Case reports noting complications associated with this technique have been reported; rarely including pneumocephalus. Complications from the pneumocephalus are even less commonly reported. Though rare following an ESI and generally self-limited without complication, pneumocephalus should be considered in the differential diagnosis when evaluating a patient with neurologic deficits after instrumentation.
Assuntos
Analgesia Epidural/efeitos adversos , Dor nas Costas/tratamento farmacológico , Vértebras Lombares/patologia , Pneumocefalia/induzido quimicamente , Pneumocefalia/diagnóstico , Convulsões/induzido quimicamente , Esteroides/administração & dosagem , Adulto , Espaço Epidural , Feminino , Humanos , Pneumocefalia/fisiopatologia , Fatores de Tempo , Resultado do TratamentoAssuntos
Ergolinas/efeitos adversos , Neoplasia Endócrina Múltipla Tipo 1/complicações , Pneumocefalia/induzido quimicamente , Prolactinoma/tratamento farmacológico , Adulto , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Cabergolina , Ergolinas/administração & dosagem , Ergolinas/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , ComprimidosRESUMO
Treatment of patients with prolactinomas consists primarily of dopamine agonists (DA). When these drugs reduce the size of invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. Pneumocephalus and cerebrospinal fluid leakage have been reported. A 56 year old male was admitted to the emergency unit with an intracranial hypertension syndrome. He had been treated for 2 weeks with cabergoline after an invasive prolactinoma was discovered. Brain CT showed frontal interhemispheric pneumocephalus on the previous tumor cavity, and bony defect on the sellar floor. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and subtotal tumor removal were performed. The literature is reviewed looking for possible pathophysiological mechanism, prevention and treatment.
Assuntos
Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Ergolinas/efeitos adversos , Ergolinas/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Pneumocefalia/induzido quimicamente , Prolactinoma/tratamento farmacológico , Cabergolina , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Prolactinoma/patologia , Tomografia Computadorizada por Raios XRESUMO
El tratamiento de los pacientes con prolactinomas consiste principalmente en el uso de agonistas dopaminérgicos (AD). Cuando estos fármacos reducen el tamaño de prolactinomas invasivos, los espacios intra y extracraneal pueden llegar a comunicarse. El neumoencéfalo y la fístula de líquido cefalorraquídeo (LCR) han sido descritos. Un paciente varón de 56 años acude al servicio de urgencias con un síndrome de hipertensión intracraneal. Tras haber sido diagnosticado de un prolactinoma invasivo, había sido tratado con cabergolina durante 2 semanas. El TC craneal mostró neumoencéfalo frontal interhemisférico en la cavidad que ocupaba previamente el tumor, y un defecto óseo en el suelo de la silla turca. Se realizó evacuación del pneumoencéfalo, reparación de los defectos craneales y meníngeos y exéresis subtotal del tumor. Se revisa la literatura, los posibles mecanismos fisiopatológicos, modos de prevención y tratamiento (AU)
Treatment of patients with prolactinomas consists primarily of dopamine agonists (DA). When these drugs reduce the size of invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. Pneumocephalus and cerebrospinal fluid leakage have been reported. A 56 year old male was admitted to the emergency unit with an intracranial hypertension syndrome. He had been treated for 2 weeks with cabergoline after an invasive prolactinoma was discovered. Brain CT showed frontal interhemispheric pneumocephalus on the previous tumor cavity, and bony defect on the sellar floor. Evacuation of pneumocephalus, reparation of cranial and meningeal defects and subtotal tumor removal were performed. The literature is reviewed looking for possible pathophysiological mechanism, prevention and treatment (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/induzido quimicamente , Prolactinoma/complicações , Agonistas de Dopamina/efeitos adversos , Prolactinoma/tratamento farmacológico , Derrame Subdural/complicações , Tomografia Computadorizada por Raios XAssuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/efeitos adversos , Pneumocefalia/induzido quimicamente , Doença Aguda , Administração Intranasal/efeitos adversos , Adulto , Doença Crônica , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Fístula/induzido quimicamente , Fístula/diagnóstico , Humanos , Masculino , Descongestionantes Nasais/efeitos adversos , Doenças dos Seios Paranasais/induzido quimicamente , Doenças dos Seios Paranasais/diagnóstico , Pneumocefalia/diagnósticoAssuntos
Agonistas de Dopamina/efeitos adversos , Ergolinas/efeitos adversos , Neoplasias Hipofisárias/tratamento farmacológico , Pneumocefalia/induzido quimicamente , Prolactinoma/tratamento farmacológico , Adulto , Cabergolina , Agonistas de Dopamina/uso terapêutico , Ergolinas/uso terapêutico , Humanos , MasculinoAssuntos
Ependimoma/cirurgia , Óxido Nitroso/efeitos adversos , Pneumocefalia/induzido quimicamente , Neoplasias da Medula Espinal/cirurgia , Adulto , Anestésicos Inalatórios/efeitos adversos , Nível de Alerta/efeitos dos fármacos , Feminino , Humanos , Hipertensão/diagnóstico , Complicações Intraoperatórias/diagnóstico , Resultado do TratamentoAssuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/efeitos adversos , Pneumocefalia/induzido quimicamente , Cocaína/administração & dosagem , Feminino , Seguimentos , Humanos , Inalação , Pessoa de Meia-Idade , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/terapia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Fatal brain stem failure developed suddenly in a 40-year-old male undergoing irrigation of an infected wound consequent to lumbar disc space infection. CT of head revealed posterior fossa pneumacephalus compressing the brain stem, which most likely developed from ingress of nascent oxygen under pressure through a defect in the thecal sac.
Assuntos
Anti-Infecciosos Locais/efeitos adversos , Discotomia , Peróxido de Hidrogênio/efeitos adversos , Pneumocefalia/induzido quimicamente , Infecção da Ferida Cirúrgica/tratamento farmacológico , Adulto , Evolução Fatal , Humanos , Vértebras Lombares/cirurgia , Masculino , Irrigação Terapêutica/efeitos adversosRESUMO
Nitrous oxide anesthesia has been implicated as contributing to the development of delayed tension pneumocephalus following surgery performed in the sitting position. The authors tested the hypothesis that withdrawal of nitrous oxide anesthesia administered during formation of an intracranial gas cavity would lead to a decrease in intracranial pressure (ICP) as N2O diffuses from the cavity back into the blood. Ten halothane-anesthetized rabbits were prepared for measurement of supracortical ICP and arterial blood pressure (BP) and for intracranial volume alterations via a cisterna magna infusion catheter. Hyperventilation (Paco2 = 28-30 mmHg) and mannitol were used to shrink the brain to accommodate intracranial infusion of either air or lactated Ringer's (LR) solution, which was used to elevate ICP to between 10-15 mmHg from a baseline ICP of 2.1 +/- 2.5 mmHg over a period of 8 to 10 min. Following stabilization at an elevated ICP, inhalation of nitrous oxide (75%) was either initiated or withdrawn (if already present during the induced ICP increase) and the subsequent changes in mean ICP and BP were recorded. Following ICP elevation with LR to 10 +/- 1 mmHg, initiation of 75% N2O administration resulted in no change in ICP and modest increases (P less than 0.05) in BP and cerebral perfusion pressure (CPP = BP - ICP) after 4 min. However, when ICP was raised (to 12 +/- 3.5 mmHg) with intracranial air infusion, subsequent initiation of 75% N2O inhalation caused an abrupt ICP increase to 22.3 +/- 9 mmHg (from control P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Pressão Intracraniana/efeitos dos fármacos , Óxido Nitroso/efeitos adversos , Pneumocefalia/induzido quimicamente , Anestesia por Inalação/efeitos adversos , Animais , Gasometria , Pressão Sanguínea/efeitos dos fármacos , Feminino , Masculino , CoelhosRESUMO
The authors reported a case of pneumocephalus induced by bromocriptine (Bc) treatment for a recurrent invasive prolactinoma. The patient was a 38-year old man, who had been treated for 12 years, with three times of craniotomies and two times of irradiation therapies. CT scan showed the recurrence of the tumor, which extended into bilateral middle fossa, left orbit and left cerebellopontine angle. Serum prolactin levels elevated to 35,200 ng/ml. Then Bc was administered in a dose of 5 mg/day. Serum PRL concentration fell to 2,090 ng/ml one month after the initiation of the treatment, when he complained of headache, nausea and vomiting. Since these symptoms were considered as the side effects of Bc, the dose was reduced to 2.5 mg/day. Three weeks later, plain craniograms showed marked pneumocephalus, while no tumor was found on CT scan. The administration of Bc was stopped and he was prescribed a complete rest for a month. The air was collected again when he began to walk around. Therefore, the transsphenoidal operation was performed in order to pack the sella turcica and sphenoid sinus with muscle pieces. Since the pneumocephalus could not be cured, the muscle, taken from the thigh, was spread throughout the left middle fossa by the front-temporal craniotomy. When Bc reduces the size of the invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. The greatest care should be taken for pneumocephalus, CSF rhinorrhea and/or meningitis during the Bc treatment of prolactinomas.