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Emergency Radiology

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01.12.2013 | Case Report

Tension pneumocephalus: a case report with review of literature

verfasst von: Shah Sweni, Subramanian Senthilkumaran, Namasivayam Balamurugan, Ponniah Thirumalaikolundusubramanian

Erschienen in: Emergency Radiology | Ausgabe 6/2013

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Abstract

Tension Pneumocephalus (PC) was described 50 years ago. A case of pneumocephalus (PC) following cervical epidural injection in a 50-year-old male worsened by air travel and manifested as tension pneumocephalus, confirmed by advanced neuroimaging, is reported for the first time along with literature review. The patient underwent emergent frontal burr hole evacuation and air gushed under pressure. The patient recovered well and is stable during a follow-up of 12 months. Presenting features and clinical course along with Mount Fuji sign, Peaking sign, and air bubble sign observed in this case are described. Also, the importance of considering neurosurgical and spinal procedures leading to PC have to be considered by practitioners before issuing fitness certificate before air travel, as PC is likely to get transformed to tension PC and can cause an in-flight emergency.

Sprague A, Poulgrain P (1999) Tension pneumocephalus: a case report and literature review. J clin neurosci: official j Neurosurg Soc Australas 6(5):418–424. doi:10.1054/jocn.1998.0096

Schirmer C, Heilman C, Bhardwaj A (2010) Pneumocephalus: case illustrations and review. Neurocrit Care 13(1):152–158. doi:10.1007/s12028-010-9363-0 PubMedCrossRef

Wolff E (1914) Luftansammlung im rechten Seitenventrikel des Gehirns (Pneumozephalus). Münch Med Wochenschr 61:899

Luckett W (1913) Air in the ventricles of the brain, following a fracture of the skull: report of a case. Surg Gynecol Obstet 17:237–240

Paemeleire K, Santens P, Boon P (2008) Mount Fuji sign following otogenic meningitis. Acta Neurol Belg 108(3):116PubMed

Ectors PMF (1988) Postoperative tension pneumocephalus. J Neurosurg 69(4):641–642

Kessler LA, Stern WZ (1962) The ventriculopleural shunt procedure for hydrocephalus. Case report of an unusual complication. J Pediatr 60:418–420PubMedCrossRef

Donovan DJ, Iskandar JI, Dunn CJ, King JA (2008) Aeromedical evacuation of patients with pneumocephalus: outcomes in 21 cases. Aviat, space environ med 79(1):30–35CrossRef

Osborn AG, Daines JH, Wing SD, Anderson RE (1978) Intracranial air on computerized tomography. J Neurosurg 48(3):355–359. doi:10.3171/jns.1978.48.3.0355 PubMedCrossRef

10.

Ishiwata Y, Fujitsu K, Sekino T, Fujino H, Kubokura T, Tsubone K, Kuwabara T (1988) Subdural tension pneumocephalus following surgery for chronic subdural hematoma. J Neurosurg 68(1):58–61. doi:10.3171/jns.1988.68.1.0058 PubMedCrossRef

11.

Jakhere SG, Yadav DA, Jain DG, Balasubramaniam S (2011) Does the Mount Fuji Sign always signify ‘tension’ pneumocephalus? An exception and a reappraisal. Eur J Radiol Ext 78(1):e5–e7CrossRef

12.

Michel SJ (2004) The Mount Fuji sign1. Radiology 232(2):449–450. doi:10.1148/radiol.2322021556 PubMedCrossRef

13.

Markham JW (1967) The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta neurochir 16(1–2):1–78. doi:10.1007/bf01401900 PubMedCrossRef

14.

Mammis A, Agarwal N, Eloy JA, Liu JK (2013) Intraventricular tension pneumocephalus after endoscopic skull base surgery. J neurol surg Part A, Central Eur neurosurg. doi:10.1055/s-0032-1328954

15.

Tanaka A, Matsumoto N, Fukushima T, Tomonaga M (1986) Spontaneous intracerebral pneumocephalus after ventriculoperitoneal shunting in patients with posterior fossa tumors: report of two cases. Neurosurgery 18(4):499–501PubMedCrossRef

16.

Simopoulos T, Peeters-Asdourian C (2001) Pneumocephalus after cervical epidural steroid injection. Anesth Analg 92(6):1576–1577PubMedCrossRef

17.

Scott DB (1997) Identification of the epidural space: loss of resistance to air or saline? Reg Anesth 22(1):1–2PubMedCrossRef

18.

Kinsley S, Dougherty J (1993) Tension pneumocephalus related to an epidermoid tumor of ethmoid sinus origin. Ann Emerg Med 22(2):259–261. doi:10.1016/S0196-0644(05)80217-3 PubMedCrossRef

19.

Goldmann RW (1986) Pneumocephalus as a consequence of barotrauma. JAMA 255(22):3154–3156. doi:10.1001/jama.1986.03370220116039 PubMedCrossRef

20.

Wang H-C, Hwang J-C, Peng J-P, Hsieh C-H, Liliang P-C (2006) Tension pneumocephalus—a rare complication of radiotherapy: a case report. J emerg med 31(4):387–389PubMedCrossRef

21.

Nicholson B, Dhindsa H (2010) Traumatic tension pneumocephalus after blunt head trauma and positive pressure ventilation. Prehospital Emerg Care 14(4):499–504. doi:10.3109/10903120903564522 CrossRef

22.

Acikbas SC, Akyuz M, Kazan S, Tuncer R (2002) Complications of closed continuous lumbar drainage of cerebrospinal fluid. Acta Neurochir (Wien) 144(5):475–480. doi:10.1007/s007010200068 CrossRef

23.

Robin N, Moloney D, Horton W (1996) Tension pneumocephalus: a case following petrosectomy. Br J Hosp Med 55(1–2):65–66PubMed

24.

Javan R, Duszak R Jr, Eisenberg AD, Eggers FM (2011) Spontaneous pneumocephalus after commercial air travel complicated by meningitis. Aviation, space Environ Med 82(12):1153–1156CrossRef

25.

Mahabir RC, Szymczak A, Sutherland GR (2004) Intracerebral pneumatocele presenting after air travel. J Neurosurg 101(2):340–342. doi:10.3171/jns.2004.101.2.0340 PubMedCrossRef

26.

Kozikowski GP, Cohen SP (2004) Lumbar puncture associated with pneumocephalus: report of a case. Anesth Analg 98(2):524–526, table of contentsPubMedCrossRef

27.

Nolan RB, Masneri DA, Pesce D (2009) Pneumocephalus after epidural injections. BMJ case reports. doi:10.1136/bcr.2006.044412 PubMed

28.

Guarino AH, Wright NM (2005) Pneumocephalus after a lumbar epidural steroid injection. Pain physician 8(2):239–241PubMed

29.

Hawley JS, Ney JP, Swanberg MM (2005) Subarachnoid pneumocephalus from epidural steroid injection. Headache 45(3):247–248. doi:10.1111/j.1526-4610.2005.05053_2.x PubMedCrossRef

30.

Venkat A (2006) Images in emergency medicine. Ann Emerg Med 47(2):209PubMedCrossRef

31.

Hutton GJ, Avila M, Suarez GA (2009) Pneumocephalus after an epidural steroid injection. Clin Neurol Neurosurg 111(3):309–310. doi:10.1016/j.clineuro.2008.10.009 PubMedCrossRef

32.

Macintosh RR, Lee JA, Atkinson RS, Watt MJ (1985) Sir Robert Macintosh’s lumbar puncture and spinal analgesia: intradural and extradural. Churchill Livingstone, New York

33.

Waldman SD (2001) Interventional pain management, 2nd edn. Saunders, Philadelphia

34.

Reynolds AF Jr, Roberts PA, Pollay M, Stratemeier PH (1985) Quantitative anatomy of the thoracolumbar epidural space. Neurosurgery 17(6):905–907PubMedCrossRef

35.

Kawamata T, Omote K, Matsumoto M, Toriyabe M, Ito T, Namiki A (2003) Pneumocephalus following an epidural blood patch. Acta anaesthesiol Scand 47(7):907–909PubMedCrossRef

36.

Seth R, Mir S, Dhir JS, Cheeseman C, Singh J (2009) Fitness to fly post craniotomy—a survey of medical advice from long-haul airline carriers. Br J Neurosurg 23(2):184–187. doi:10.1080/02688690802669351 PubMedCrossRef

37.

Amato-Watkins A, Rao VM, Leach P (2012) Air travel after intracranial surgery: a survey of advice given to patients by consultant neurosurgeons in the UK. Br J Neurosurg. doi:10.3109/02688697.2012.716176 PubMed

38.

Andersson N, Grip H, Lindvall P, Koskinen LO, Brandstrom H, Malm J, Eklund A (2003) Air transport of patients with intracranial air: computer model of pressure effects. Aviation space Environ Med 74(2):138–144

39.

Beda RD, Khot SP, Manning T, Walker M (2007) Airhead: intraparenchymal pneumocephalus after commercial air travel. Surg Neurol 68(6):648–649. doi:10.1016/j.surneu.2007.08.026 PubMedCrossRef

40.

Chan YP, Yau CY, Lewis RR, Kinirons MT (2000) Acute confusion secondary to pneumocephalus in an elderly patient. Age ageing 29(4):365–367PubMedCrossRef

41.

Canavan LOR (1991) Dural sinus air without head trauma or surgery: CT demonstration. J Comput Assist Tomogr 15(3):526–527PubMed

42.

Jensen MB, Adams HP (2004) Pneumocephalus after air travel. Neurology 63(2):400–401PubMedCrossRef

43.

M√ºller J, Hermes M, Piepgras U (1995) Adolf Bingel, the second inventor of lumbar pneumencephalography. Am J Neuroradiol 16(3):487–490

44.

Suzuki Y, Fujii T (2010) Effect of syneruptive decompression path on shifting intensity in basaltic sub-Plinian eruption: implication of microlites in Yufune-2 scoria from Fuji volcano, Japan. J Volcanol Geotherm Res 198(1–2):158–176. doi:10.1016/j.jvolgeores.2010.08.020 CrossRef

45.

Prakash B, Pranesh MB, Parimalam N, Harish Kumar R (2011) Hyperostosis frontalis interna mimicking Mount Fuji sign. J Assoc Physicians India 59:181–183PubMed

46.

Yamashita S, Tsuchimochi W, Yonekawa T, Kyoraku I, Shiomi K, Nakazato M (2009) The Mount Fuji sign on MRI. Intern Med 48(17):1567–1568PubMedCrossRef

47.

Sethi S (2009) Tension pneumocephalus-CT-Peaking Sign. Sumer's Radiology Site, From http://sumerdoc.blogspot.co.uk/2009/11/tension-pneumocephalus-ct-peaking-sign.html. Accessed 01 June 2013, vol 2013.

48.

Pop PM, Thompson JR, Zinke DK, Hasso AN, Hinshaw DB (1982) Tension pneumocephalus. J Comput Assist Tomogr 6(5):894–901PubMedCrossRef

Titel: Tension pneumocephalus: a case report with review of literature
verfasst von: Shah Sweni
Subramanian Senthilkumaran
Namasivayam Balamurugan
Ponniah Thirumalaikolundusubramanian
Publikationsdatum: 01.12.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Emergency Radiology / Ausgabe 6/2013
Print ISSN: 1070-3004
Elektronische ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-013-1135-7

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