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Case Report
- Neurosurgery
- What should an intensivist know about pneumocephalus and tension pneumocephalus?
- Bhushan Sudhakar Wankhade, Maged Mohsen Kamel Beniamein, Zeyad Faoor Alrais, Jyoti Ittoop Mathew, Ghaya Zeyad Alrais
- Acute Crit Care. 2023;38(2):244-248. Published online April 13, 2022
- DOI: https://doi.org/10.4266/acc.2021.01102
- 15,389 View
- 394 Download
- 5 Web of Science
- 6 Crossref
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Abstract
PDF - Collection of air in the cranial cavity is called pneumocephalus. Although simple pneumocephalus is a benign condition, accompanying increased intracranial pressure can produce a life-threatening condition comparable to tension pneumothorax, which is termed tension pneumocephalus. We report a case of tension pneumocephalus after drainage of a cerebrospinal fluid hygroma. The tension pneumocephalus was treated with decompression craniotomy, but the patient later died due to the complications related to critical care. Traumatic brain injury and neurosurgical intervention are the most common causes of pneumocephalus. Pneumocephalus and tension pneumocephalus are neurosurgical emergencies, and anesthetics and intensive care management like the use of nitrous oxide during anesthesia and positive pressure ventilation have important implications in their development and progress. Clinically, patients can present with various nonspecific neurological manifestations that are indistinguishable from a those of a primary neurological condition. If the diagnosis is questionable, patients should be investigated using computed tomography of the brain. Immediate neurosurgical consultation with decompression is the treatment of choice.
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Citations
Citations to this article as recorded by
- Sudden-onset, non-traumatic large volume pneumocephalus following presentation of acute bacterial meningitis
Alexandra Krez, Michael Malinzak, Colby Feeney
BMJ Case Reports.2024; 17(1): e256194. CrossRef - Fatal postoperative tension pneumocephalus after acute subdural hematoma evacuation: a case report
Nikolaos Gkantsinikoudis, Panagiotis Monioudis, Elias Antoniades, Vassilios Tsitouras, Ioannis Magras
International Journal of Neuroscience.2024; : 1. CrossRef - Pneumocephalus; a rare cause of coma
Elisavet Simoulidou, Vivian Georgopoulou, Panagiotis Kalmoukos, Dimitrios Kouroupis, Nikoleta Moscha, Maria Sidiropoulou, Sofia Chatzimichailidou, Konstantinos Petidis, Athina Pyrpasopoulou
The American Journal of Emergency Medicine.2023; 68: 215.e1. CrossRef - Pneumocephalus secondary to epidural analgesia: a case report
Maira Ahmad, Shannay Bellamy, William Ott, Rany Mekhail
Journal of Medical Case Reports.2023;[Epub] CrossRef - Transnasal Endoscopic Treatment of Tension Pneumocephalus Caused by Posttraumatic or Iatrogenic Ethmoidal Damage
Goran Latif Omer, Riccardo Maurizi, Beatrice Francavilla, Kareem Rekawt Hama Rashid, Gianluca Velletrani, Hasan Mustafa Salah, Giulia Marzocchella, Mohammed Ibrahim Mohialdeen Gubari, Stefano Di Girolamo, Rong-San Jiang
Case Reports in Otolaryngology.2023; 2023: 1. CrossRef - Tension pneumocephalus as a complication of surgical evacuation of chronic subdural hematoma: case report and literature review
Mohammed A. Azab, Ahmed Hazem, Brandon Lucke-Wold
Exploration of Neuroprotective Therapy.2023; 3(4): 177. CrossRef
- Sudden-onset, non-traumatic large volume pneumocephalus following presentation of acute bacterial meningitis
Original Article
- Clinical Study of Diffusion Hypoxia in Early Period after Nitrous Oxide Anesthesia
- Hae Keum Kil, Won Oak Kim, Sung Jin Lee, Woo Kyung Lee
- Korean J Crit Care Med. 1998;13(1):55-60.
- 1,878 View
- 15 Download
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Abstract
PDF
- Introduction: Anesthesiologists have been aware of the dangers of diffusion hypoxia in the early postoperative period after nitrous oxide anesthesia, but it was suggested of a little clinical significance in healthy patients. Goal of this study is to re-evaluate the possibility of diffusion hypoxia.
METHODS
Eighty patients who were scheduled for vitrectomy were allocated to two groups by normal and abnormal chest X-ray findings and each group was divided into two subgroups by N2O concentration (1-a, 2-a; 50%, 1-b, 2-b; 60%). One and half hours after anesthesia, end-tidal alveolar concentration of oxygen (et-O2), N2O (et-N2O), and PaO2 were measured for 10 minutes after the inspired gases were changed to room air 2 L/minute with controlled ventilation in group 1-a. Those parameters were re-measured after re-administration of O2 and N2O of 50% of each for an hour and the inpired gases were changed to room air again.
RESULTS
In group 1-a, there was no significant differences of et-N2O and PaO2 after 5 minutes by air flow. And there was no differences of et-N2O and PaO2 between group 1-a and 1-b by et-N2O after 4 minutes. In group 1-b, PaO2 was in normal range at 10 minutes after, although et-O2 was decreased to 14.9%. However, group 2-b showed peripheral arterial saturation lower than 96% after 6 minutes and mild hypoxemia (PaO2 75.3 mmHg) at 10 minutes.
CONCLUSIONS
We suggest that hypoxemic episode during spontaneous breathing of room air in early postoperative period after nitrous oxide anesthesia may be occur due to decreased ventilatory function rather than diffusion of nitrous oxide. However, in patients with minimal abnormal chest X-ray findings even without clinical symptoms, it would be better to avoid high concentration of nitrous oxide.
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