Delayed Pneumocephalus-Induced Cranial Neuropathy

Marupudi, Neena I.; Mittal, M. M.; Mittal, Sandeep

doi:10.1155/2013/105087

Cited by 12 publications

(6 citation statements)

References 8 publications

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“…The formation of cracks across the surface of agarose gel reported in “ Effects of ICA volume ≥ 30 ml ” section suggests that it may not be safe for pneumocephalus patients with ICA volumes of 30 ml or larger to embark on air travel, as this may lead to complications due to elevated ICP and cerebral herniation. Large expansion of ICA may also lead to more severe neurological disorders such as epilepsy 29 and focal neurological deficits, depending on the location of the ICA within the brain 30 , 31 . Although the experiments performed in “ Effects of ICA volume ≤ 20 ml and ROC ” section were limited only to 15 mmHg, the 30 ml threshold for unsafe travel applies also to other values of initial ICP.…”

Section: Discussionmentioning

confidence: 99%

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Lim

Lan

Ooi

et al. 2020

Sci Rep

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This study investigates the effects of aircraft cabin pressure on intracranial pressure (ICP) elevation of a pneumocephalus patient. We propose an experimental setup that simulates the intracranial hydrodynamics of a pneumocephalus patient during flight. It consists of an acrylic box (skull), air-filled balloon [intracranial air (ICA)], water-filled balloon (cerebrospinal fluid and blood) and agarose gel (brain). The cabin was replicated using a custom-made pressure chamber. The setup can measure the rise in ICP during depressurization to levels similar to that inside the cabin at cruising altitude. ΔICP, i.e. the difference between mean cruising ICP and initial ICP, was found to increase with ICA volume and ROC. However, ΔICP was independent of the initial ICP. The largest ΔICP was 5 mmHg; obtained when ICA volume and ROC were 20 ml and 1,600 ft/min, respectively. The postulated ICA expansion and the subsequent increase in ICP in pneumocephalus patients during flight were successfully quantified in a laboratory setting. Based on the quantitative and qualitative analyses of the results, an ICA volume of 20 ml and initial ICP of 15 mmHg were recommended as conservative thresholds that are required for safe air travel among pneumocephalus patients. This study provides laboratory data that may be used by doctors to advise post-neurosurgical patients if they can safely fly. Craniotomy refers to the surgical removal of a portion of the skull to gain access to the contents of the intracranial cavity. The procedure usually involves exposing the brain after opening its membranous coverings 1 , which inevitably expose the human brain to surrounding air. Varying amounts of air within the intracranial cavity (ICA) (known as pneumocephalus) remain after craniotomy 2. In most cases, pneumocephalus is not life-threatening as the ICA is normally absorbed into the systemic circulation over a period of several weeks 3-5. Safety concerns arise when patients with pneumocephalus engage in air travel before the ICA is fully absorbed. Air safety regulations require cabins of commercial aircraft to be pressurized to a standardized minimum of 75 kPa, which is approximately 75% that of atmospheric pressure at sea level (101.3 kPa), at cruising altitude 6,7. Consequently, during air travel, the ambient pressure may be as much as 25 kPa lower than the initial pressure of the ICA, which is at 101.3 kPa. According to Boyle's law, the difference in pressure between the aircraft cabin and the ICA would result in an increase in the ICA volume, as the ICA expands to equilibrate with the cabin pressure. The expansion, which takes place inside the rigid cranium, may cause cerebral compression that can lead to elevations in the intracranial pressure (ICP). A mild increase in ICP is tolerable. However, if the increase in ICP is too large, cerebral herniation may occur, which severely endangers the life of the pneumocephalus patient. In spite of the potential life-threatening event, pneumocephalus and air travel safety remains a controversial topic 8...

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Section: Discussionmentioning

confidence: 99%

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Lim

Lan

Ooi

et al. 2020

Sci Rep

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“…described a case of a patient who developed a bilateral pupil-sparing oculomotor nerve palsy from pneumocephalus after a right occipital craniotomy with complete resection of the cystic pineal mass through a transtentorial interhemispheric approach. [ 6 ] It can be argued that pneumocephalus did not cause this nerve palsy, as pupil-sparing palsies are most commonly due to ischemic events and involve the nerve in its extra axial course. [ 9 ] Conversely, a nonpupil sparing palsy is due to compression of the nerve’s outer parasympathetic fibers that supply the sphincter pupillae.…”

Section: Discussionmentioning

confidence: 99%

“…A review of the literature highlights a shortage of reports on isolated cranial nerve deficits related to pneumocephalus. [ 6 ] We present a case of a patient who underwent a frontoparietal craniotomy for a postoperative CSF leak and subsequently developed a unilateral oculomotor nerve palsy as a direct result of compression from pneumocephalus.…”

Section: Introductionmentioning

confidence: 99%

Pneumocephalus causing oculomotor nerve palsy: A case report

Goodrich¹,

Wolberg

Kashyap

et al. 2020

Surgical Neurology International

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Background: Pneumocephalus, the presence of gas or air within the intracranial cavity, is a common finding after cranial procedures, though patients often remain asymptomatic. Rare cases of cranial nerve palsies in patients with pneumocephalus have been previously reported. However, only two prior reports document direct unilateral compression of the third cranial nerve secondary to pneumocephalus, resulting in an isolated deficit. Case Description: A 26-year-old male developed a unilateral oculomotor (III) nerve palsy after repair of a cerebrospinal fluid leak. The pneumocephalus was treated with a combination of an epidural drain, external ventricular drain (EVD), and high-flow oxygen. Following treatment, repeat computed tomography imaging of the head demonstrated that the pneumocephalus was progressively resorbed and the patient’s deficit resolved. Conclusion: In rare cases, isolated cranial nerve palsies, specifically of the third cranial nerve, can result from pneumocephalus following cranial procedures. Acute cranial nerve palsy secondary to pneumocephalus will often resolve without intervention as the air is resorbed, but direct decompression with an epidural drain and an EVD may expedite the resolution of deficits.

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“…Computed tomography (CT) usually confirms the diagnosis with frontal pneumocephalus being most common followed by post-op neurosurgeries [3]. Pneumocephalus can be typed as acute (< 72 h) or delayed (> 72 h) [5,6]. Based on the clinical features, pneumocephalus can be differentiated into simple and tension pneumocephalus and the distinction between them is of clinical importance as the latter constitutes as a neurosurgical emergency [4].…”

Section: Introductionmentioning

confidence: 99%

A very rare case of isolated aphasia due to tension pneumocephalus after subdural hematoma (SDH) evacuation: a case presentation

Chagalakonda

Adulla²,

Chamle

et al. 2019

Egypt J Neurosurg

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Background: Pneumocephalus is a common complication presented as air in the cranial cavity after cranial surgery. We present a very rare case of isolated new onset aphasia due to pneumocephalus after evacuation of subdural hematoma (SDH). Tension pneumocephalus presenting as isolated aphasia has not been reported earlier although associated paresis has been reported. Case presentation: We present the case of a 13-year-old male child with a history of fall before the onset of symptoms like headache and vomiting. The immediate MRI of the brain showed left-sided frontotemporoparietal subacute SDH with significant midline shift and subfalcine herniation. The child was subsequently managed with craniotomy and evacuation of hematoma with duraplasty. The patient developed aphasia on second-day postsurgery which progressed from moderate to severe aphasia by day 4. Computed tomography (CT) scan revealed pneumocephalus and an increase in the pneumocephalus in imaging on post-op day 4 with no other abnormalities. The condition was then managed by removing the subgaleal drain and administering high flow oxygen of 10 l/min. Conclusion: This case signifies the importance of proper diagnosis of new-onset neurological deficits after evacuation of subdural hematoma for the better outcome.

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Delayed Pneumocephalus-Induced Cranial Neuropathy

Cited by 12 publications

References 8 publications

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Pneumocephalus and air travel: an experimental investigation on the effects of aircraft cabin pressure on intracranial pressure

Pneumocephalus causing oculomotor nerve palsy: A case report

A very rare case of isolated aphasia due to tension pneumocephalus after subdural hematoma (SDH) evacuation: a case presentation

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