1/22. Gas in the cranium: an unusual case of delayed pneumocephalus following craniotomy.We present the case history of a 23-year-old man who underwent frontal craniotomy followed by radiotherapy for a Grade III anaplastic glioma. magnetic resonance imaging (MRI) at the 3-month follow-up showed significant tumour response. He became unwell some weeks after the MRI with an upper respiratory tract infection, severe headache and mild right-sided weakness. A computed tomographic (CT) scan showed a very large volume of intracranial gas, thought to have entered via a defect in the frontal air sinus after craniotomy and brought to light by blowing his nose. Intracranial air is frequently present after craniotomy, but it is normally absorbed within 34 weeks. The presence of pneumocephalus on a delayed postoperative CT scan should raise the possibility of a cerebrospinal fluid (CSF) fistula, or infection with a gas-forming organism. Many CSF fistulae require surgical closure in order to prevent potentially life-threatening central nervous system infection and tension pneumocephalitis. Immediate neurosurgical review is advisable.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
2/22. Intracranial placement of a nasogastric tube after severe craniofacial trauma.Complications of intracranial placement of a nasogastric tube in patients with complex facial and skull base fractures are infrequent, though the associated morbidity and mortality are high. In such situations some authors advocate craniotomy to allow removal of the tube in several linear segments under direct visualization. Others advise tube removal nasally under antibiotic coverage. We present a case of complex craniofacial fracture in which a nasogastric tube was positioned intracranially 48 hours after admission. The tube was quickly removed through the nose, and the patient was discharged without neurologic problems.- - - - - - - - - - ranking = 3keywords = gas (Clic here for more details about this article) |
3/22. pneumocephalus secondary to septic thrombosis of the superior sagittal sinus: report of a case.pneumocephalus secondary to septic superior sagittal sinus thrombosis (SSSST) is extremely rare. We report computed tomography (CT) findings in a 63-year-old man with SSSST caused by the gas-forming organism klebsiella pneumoniae. The patient presented with fever, chills, general weakness, and spontaneous progressive swelling of the right frontoparietal scalp. CT revealed a gas-containing abscess over the right frontoparietal subgaleal region and in the superior sagittal sinus. Surgical drainage of the subgaleal abscess was performed and blood and pus cultures grew klebsiella pneumoniae. The patient died of sepsis on the 6th day of hospitalization.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
4/22. Intraparenchymal tension pneumatocele complicating frontal sinus osteoma: case report.OBJECTIVE AND IMPORTANCE: A relatively rare condition of intraparenchymal tension pneumatocele secondary to a frontal sinus osteoma eroding posteriorly and breaching dura mater is described. The scanty body of literature on this subject is briefly summarized, and the importance of this condition as a result of its life-threatening but readily treatable intracranial mass effect is outlined. CLINICAL PRESENTATION: The patient presented with acute deterioration in conscious state and lateralizing signs from the mass effect of gas under tension. Two weeks earlier, he had experienced vague and subtle changes in personality noticeable only to his family. INTERVENTION: The patient was cured by a frontal craniotomy, partial excision of the osteoma, and suture repair of the dural defect after evacuation of the pressurized air cavity. CONCLUSION: This rare condition should be urgently treated in the event of acute deterioration. To prevent a life-threatening situation from arising, elective surgery should be considered for patients known to have air sinus osteomas that are at risk of erosion into the cranial cavity.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
5/22. Disseminated pneumocephalus secondary to an unusual facial trauma.pneumocephalus can be secondary to a postintrathecal procedure, sinus fracture, basilar skull fracture, congenital skull defect, neoplasm, gas producing organism, barotrauma, neurosurgery, paranasal sinus surgery, mask or nasal continuous positive-airway pressure. Unusual facial traumas can also be rare causes of pneumocephalus. Here, we present such a case in whom an air compressor tip injury to both eyes led to the disseminated pneumocephalus. We report this rare case with the computed tomography findings and try to explain the possible mechanism of the pnemocephalus.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
6/22. Tension pneumocephalus: an unusual complication after lung resection.On day 5, after right upper lobectomy, the patient developed headache, confusion and right hemiparesis and there was clear fluid drainage from the chest tube. Computed tomography (CT) scan of the head showed gas in the ventricles and subarachnoid space. The fluid from the drain was positive for Beta-2 transferrin signifying cerebrospinal fluid (CSF) fistula. Patient recovered completely with conservative management.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
7/22. pneumocephalus in neonatal meningitis: diffuse, necrotizing meningo-encephalitis in Citrobacter meningitis presenting with pneumatosis oculi and pneumocephalus.OBJECTIVE/PATIENT: Gas-containing encephalitis is rarely associated with neonatal meningitis. We report a case of a 19-day-old baby who presented with a rapid onset of septic shock complicated by progressively increasing gas accumulation within the brain and anterior chamber of the eye. We describe the evolution of the clinical picture and the management. INTERVENTIONS: Ventilatory support, fluid resuscitation, and continuous venovenous hemofiltration were provided in view of multiple system failure. Despite effective antibiotic therapy and supportive management, the patient died with worsening accumulation of gas within the brain, resulting in brainstem death. RESULTS: Computed tomographic images were characteristic of diffuse necrotizing meningo-encephalitis. Postmortem examination showed friable brain tissue with venous infarction and extensive gas accumulation. citrobacter koseri was identified from the blood and cerebrospinal fluid cultures. CONCLUSION: This case re-emphasises the importance of C. koseri as both a community-acquired and nosocomial neonatal pathogen. Radiologic evidence suggestive of diffuse necrotizing meningo-encephalitis in combination with pneumocephalus and pneumatosis oculi in Citrobacter infections has never been described before. diagnostic imaging with computed tomographic scanning of the brain and initiation of broad-spectrum antibiotics with good penetration into cerebrospinal fluid are indicated as soon as infection with Citrobacter species is suspected clinically, with appearance of pneumatosis oculi as a rare, late finding.- - - - - - - - - - ranking = 1.5keywords = gas (Clic here for more details about this article) |
8/22. pneumocephalus associated with bacteroides fragilis meningitis.Gas within the intracranial cavity (pneumocephalus) commonly results from trauma or after surgery and rarely from infection by gas-forming organisms. The presence of pneumocephalus in the absence of injury or surgery should raise the suspicion of anaerobic infection of the central nervous system. I present a case of pneumocephalus associated with bacteroides fragilis meningitis where the diagnosis was suspected after CT findings become available. bacteroides fragilis meningitis is rare and often occurs in premature infants and neonates; only few cases are reported in adults. pneumocephalus associated with bacteroides fragilis meningitis is not described in the literature. This case also illustrates the absence of classic findings of meningeal irritation in the elderly. The literature is reviewed.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
9/22. pneumocephalus in a patient with a ventriculoperitoneal shunt after percutaneous gastrojejunostomy catheter placement: case report.BACKGROUND: Percutaneous gastrostomy and/or jejunostomy associated with ventriculoperitoneal (VP) shunting in critically ill neurosurgical patients is not an uncommon combination. Massive intraventricular pneumocephalus has not been previously reported as a complication of percutaneous gastrostomy and/or jejunostomy placement in a patient with a VP shunt. A case is presented here where we believe such a complication occurred. CASE DESCRIPTION: Our patient is a 68-year-old woman who experienced a subarachnoid hemorrhage from a right anterior choroidal aneurysm rupture. The patient underwent endovascular coiling. The patient developed a communicating hydrocephalus and eventually necessitated a VP shunt. Two weeks after shunt placement, our patient had a fluoroscopic percutaneous gastrostomy and/or jejunostomy catheter placed. A computed tomographic scan of the brain obtained after feeding tube placement for a change in mental status revealed a significant amount of air in the lateral ventricles. The patient was managed expectantly over the next several days with slow clinical and radiographic improvement. CONCLUSIONS: The etiology for the increased intraventricular pneumocephalus is believed to be retrograde leakage of air into the ventricles via the VP shunt during insufflation of the abdomen for percutaneous placement of a gastrojejunostomy feeding tube.- - - - - - - - - - ranking = 4keywords = gas (Clic here for more details about this article) |
10/22. Compressed helium injury to the orbit resulting in pneumocephalus.A 33-year-old woman received a conjunctival laceration after accidental contact with the flexible outlet tip of a tank of compressed helium while filling balloons. The gas discharged during the contact, blowing compressed helium into her right orbit, with intracranial extension. The patient was asymptomatic, except for a transient headache. She was treated with prophylactic antibiotics and observed overnight, then discharged without complication. A literature search reveals that the usual outcome for this mechanism of injury is favorable.- - - - - - - - - - ranking = 0.5keywords = gas (Clic here for more details about this article) |
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