1/97. pneumocephalus associated with ethmoidal sinus osteoma--case report.A 35-year-old female suffered sudden onset of severe headache upon blowing her nose. No rhinorrhea or signs of meningeal irritation were noted. Computed tomography (CT) with bone windows clearly delineated a bony mass in the right ethmoid sinus, extending into the orbit and intracranially. Conventional CT demonstrated multiple air bubbles in the cisterns and around the mass in the right frontal skull base, suggesting that the mass was associated with entry of the air bubbles into the cranial cavity. T1- and T2-weighted magnetic resonance (MR) imaging showed a low-signal lesion that appeared to be an osteoma but did not show any air bubbles. Through a wide bilateral frontal craniotomy, the cauliflower-like osteoma was found to be protruding intracranially through the skull base and the overlying dura mater. The osteoma was removed, and the dural defect was covered with a fascia graft. Histological examination confirmed that the lesion was an osteoma. The operative procedure resolved the problem of air entry. CT is superior to MR imaging for diagnosing pneumocephalus, by providing a better assessment of bony destruction and better detection of small amounts of intracranial air.- - - - - - - - - - ranking = 1keywords = dura mater, mater, dura (Clic here for more details about this article) |
2/97. pneumocephalus following inadvertent intrathecal puncture during epidural anesthesia: a case report and review of the literature.Regional anesthesia techniques (epidural and spinal) are preferred anesthetic modalities in modern obstetrics, in that both of these modalities enable maternal participation in the delivery process and assist in avoiding maternal aspiration associated with general anesthesia. We report an unusual and potentially severe complication of epidural anesthesia for elective repeat cesarean delivery. Following intravenous hydration and lateral uterine displacement, uneventful epidural anesthesia was administered. Toward the end of the otherwise uneventful cesarean the patient, who had been completely stable, became unresponsive, with dilated pupils that did not respond to light. The patient was immediately intubated and gradually regained consciousness and was extubated within 1 h. Cranial computed tomography disclosed pneumocephalus. Inadvertent pneumocephalus is reviewed.- - - - - - - - - - ranking = 0.77252554007499keywords = mater, dura (Clic here for more details about this article) |
3/97. Epidural and subarachnoidal pneumocephalus after epidural technique.Iatrogenic pneumocephalus is an uncommon complication observed after using the 'loss-of-resistance' technique with an air filled syringe. We report and review two cases of pneumocephalus: one subarachnoid and the other epidural.- - - - - - - - - - ranking = 0.60030722969444keywords = dura (Clic here for more details about this article) |
4/97. Iatrogenic pneumocephalus secondary to intravenous catheterization. Case report.The presence of pneumocephalus in a patient without a history of undergoing intracranial or intrathecal procedures is a significant radiographic finding that portends a violation of the dural barrier or the presence of infection. The authors report a case of iatrogenic pneumocephalus that confounded the evaluation of a patient with unrelated neurological disorders, resulting in unnecessary transfer of the patient and utilization of medical resources. A review of 100 sequential computerized tomography scans obtained in patients for any indication in the emergency department revealed a 6% incidence of iatrogenic intravenous pneumocephalus. Computerized tomography scans revealing pneumocephalus had been obtained for altered mental status, focal motor deficit, seizure, and trauma. More careful intravenous catheterization and recognition of the condition on imaging may avoid similar problems.- - - - - - - - - - ranking = 0.066700803299382keywords = dura (Clic here for more details about this article) |
5/97. An unusual fatal complication of low basilar trunk aneurysm surgery: isolated prepontine tension pneumocephalus.OBJECTIVE: A case of postoperative tension pneumocephalus after low basilar trunk aneurysm clipping is presented. To our knowledge, this is the first case of isolated prepontine tension pneumocephalus. BACKGROUND: A 63-year-old woman was admitted for repair of a basilar aneurysm that had caused a subarachnoid hemorrhage. She was cooperative and partially oriented. According to Hunt & Hess classification, she was considered Grade III. METHOD: The aneurysm was clipped, using a right lateral suboccipital craniectomy with the patient in the sitting position. In the early postoperative period, she had no new neurological deficit. However, 2 hours later the patient became lethargic and unresponsive to verbal commands. Emergency CT scan revealed an isolated prepontine tension pneumocephalus with prominent posterior displacement of the pons. She was immediately taken back to surgery. Upon incision of the dura mater, air could be heard escaping under pressure from the posterior fossa cavity. The clip was in its proper position and all arteries were patent. Spontaneous respiration and pupil reflexes returned soon after surgery, but she remained unconscious and died 3 days later. CONCLUSION: We believe that this death was directly attributable to the tension pneumocephalus and the distortion of the pons. Postoperative prepontine tension pneumocephalus, although this is an extremely rare condition, should be considered if a patient deteriorates after basilar aneurysm surgery in the sitting position.- - - - - - - - - - ranking = 0.93329919670062keywords = dura mater, mater, dura (Clic here for more details about this article) |
6/97. pneumocephalus associated with aqueductal stenosis: three-dimensional computed tomographic demonstration of skull-base defects.Ventriculoperitoneal (VP) shunt placement in patients with aqueductal stenosis has recently been reported as a cause of pneumocephalus. We report on a patient with pneumocephalus associated with aqueductal stenosis treated by VP shunting. A 29-year-old woman who had undergone a shunt operation for aqueductal stenosis 7 years previously sustained a whiplash injury in a minor traffic accident. Computed tomography (CT) revealed massive subdural pneumocephalus, and three-dimensional reconstructions of CT images clearly demonstrated defects in the skull base overlying the ethmoid sinuses. Both endoscopic III ventriculostomy and placement of external ventricular drainage were came free of symptoms and rhinorrhea ceased. Three-dimensionally reconstructed CT images were useful in detecting the extent of the patient's skull base defect. III ventriculostomy was not effective in this case. Direct closure of the skull base by craniotomy was not necessary, and a programmable valve system was effective in preventing recurrence of either pneumocephalus or rhinorrhea.- - - - - - - - - - ranking = 0.066700803299382keywords = dura (Clic here for more details about this article) |
7/97. Subdural air limits the elicitation of compound muscle action potentials by high-frequency transcranial electrical stimulation.High-frequency transcranial electrical stimulation was performed in 8 patients undergoing surgery in the sitting position. Following the opening of the dura of the posterior fossa changes in compound muscle action potentials were observed. These changes were not attributable to surgical manoeuvres at the brain stem or spinal cord, or to anaesthetic changes. In all these cases intraoperative fluoroscopy of the skull revealed a subdural air collection underneath the stimulation electrodes. Such a subdural air collection, not infrequent in patients operated on in the sitting position, limits the application of high-frequency transcranial electrical stimulation as a monitoring technique. It remains unclear if this effect is due to the increasing distance between scalp and cortex and the insulating effect of subdural air, or due to displacement of the motor cortex. The practical importance of this report is derived from the increasing application of intraoperative motor pathway monitoring.- - - - - - - - - - ranking = 0.53360642639506keywords = dura (Clic here for more details about this article) |
8/97. Subdural and intraventricular traumatic tension pneumocephalus: case report.Simple pneumocephalus most frequently arises as a complication of a head injury in which a compound basal skull fracture with tearing of the meninges allows entry of air into the cranial cavity. It can also follow a neurosurgical operation. Tension traumatic pneumocephalus with intraventricular extension is an extremely rare, potentially lethal condition that requires prompt diagnosis and treatment. We report the case of subdural and intraventricular accidental tension pneumocephalus occurring in a 26-year-old man as a result of skull fracture. This case is combined with rhinorrhea and meningitis that suggest some difficulties to treat. The operative procedure associated with medical treatment was performed and a good result was obtained.- - - - - - - - - - ranking = 0.33350401649691keywords = dura (Clic here for more details about this article) |
9/97. Dural puncture and iatrogenic pneumocephalus with subsequent transverse myelitis in a parturient.PURPOSE: To report a case of transverse myelitis following inadvertent dural puncture and iatrogenic pneumocephalus and any possible causal relationship is explored. CLINICAL FEATURES: A 32-yr-old primigravida developed a severe headache associated with pneumocephalus following accidental dural puncture when the loss of resistance to air technique was used to locate the epidural space. She was treated with oxygen 100% to promote resorption of the air and the headache resolved. One month later she developed a sensory disturbance in her feet. Neurological examination revealed reduced sensation to cold and pain to ankle level and bilateral suppressed knee and ankle reflexes but was otherwise normal. A spinal cord lesion (epidural abscess/hematoma) was excluded with an emergency T1 and T2 weighted magnetic resonance imaging (MRI) scan of the lumbar spine. Over the next 48 hr the sensory disturbance worsened to involve her legs and waist. Examination revealed a sensory loss to waist level, reduced joint position sense and vibration sense in her lower limbs and absent knee and ankle reflexes bilaterally, but normal power in both her legs. A further full length T2 weighted MRI scan of the spine showed a small area of high signal at the level of T3 compatible with transverse myelitis. This was treated with high dose corticosteroids and her symptoms resolved over the next three months. CONCLUSION: The etiology of transverse myelitis after dural puncture in a parturient could not be identified nor could any causal link be established between the dural puncture, pneumocephalus, and subsequent transverse myelitis.- - - - - - - - - - ranking = 0.40020481979629keywords = dura (Clic here for more details about this article) |
10/97. Tension pneumocephalus resulting from iatrogenic subarachnoid-pleural fistulae: report of three cases.BACKGROUND: Symptomatic pneumocephalus may result from a cerebrospinal fluid leak communicating with extradural air. However, it is a rare event after thoracic surgical procedures, and its management and physiology are not widely recognized. methods: During the past 2 years, we have identified 3 patients who developed pneumocephalus after thoracotomy for tumor resection. Only 1 patient had a discernible spinal fluid leak identified intraoperatively. Two patients experienced delayed spinal fluid drainage from their chest tubes and subsequently developed profound lethargy, confusion, and focal neurologic signs. The third patient was readmitted to the hospital with a delayed pneumothorax and altered mental status. Radiographic imaging in all patients showed significant pneumocephalus of the basilar cisterns and ventricles. RESULTS: The first 2 patients were managed by discontinuation of the chest tube suction and bedrest. The third patient underwent surgical reexploration and nerve root ligation. All 3 patients had resolution of their symptoms within 72 hours. CONCLUSIONS: pneumocephalus is a rare, but serious, complication of thoracotomy. Previous patients reported in the literature have been managed with reoperation to ligate the nerve roots. However, the condition resolved nonoperatively in 2 of our patients. Discontinuation of chest tube suction may be definitive treatment and is always the important initial management to decrease cerebrospinal fluid extravasation into the pleural space and allow normalization of neurologic symptoms.- - - - - - - - - - ranking = 0.066700803299382keywords = dura (Clic here for more details about this article) |
| | Next -> |