Imaging Diagnosis—trauma‐induced Tension Pneumocephalus

Abstract

The dog was hit by a car and had external head wounds but was neurologically normal. The head wound was superficial and was debrided. The debridment did not result in entry into the frontal sinus. However, an underlying comminuted right frontal bone fracture was detected and several small bone fragments were removed. Three weeks later, the dog developed what the owners perceived to be back pain. Within 2 days, the perceived pain progressed to inability to rise, leaning to the left, circling to the left, leftsided head tilt, and behavioral change. The dog was then referred for further evaluation. At this time, the dog had loss of menace response in the left eye, loss of corneal reflex in the left eye, head tilt to the left, tongue deviation to the left, positional nystagmus, and severe vestibular ataxia. The pupillary light responses and palpebral reflexes were normal. The proprioceptive reactions and myotatic reflexes were normal and no back pain was elicited. Clinical signs and neurologic examination suggested a multifocal CNS lesion. Because of the dog's clinical signs and history, the major considerations were meningoencephalitis, intracranial hemorrhage, and tension pneumocephalus.The leukocyte count was elevated at 20,900 cells/ml. The leukogram was consistent with a glucocorticoid-induced leukocytosis with increased segmented neutrophils at 19,019 cells/ml, decreased lymphocytes at 627 cells/ml, and a normal band neutrophil count. There was increased blood glucose at 214 mg/dl, also consistent with a stress response. The coagulation profile was normal.

Spontaneous non‐traumatic tension pneumocephalus in a dog with a nasal meningoencephalocele

“…In veterinary literature, pneumocephalus occurred secondary to trauma in only 2/8 (25 per cent) dogs, with postoperative far more common (6/8 dogs; 75 per cent). [1][2][3][4][5][6][7][8] This is the first reported case both of pneumocephalus associated with congenital nasal meningoencephalocele and spontaneous pneumocephalus associated with a non-traumatic cause in a dog. Pneumocephalus should be considered in the event of acute neurological deterioration in veterinary patients with congenital brain anomalies communicating with air-filled cavities.…”

“…1 Pneumocephalus is rare in veterinary medicine with only eight cases reported in dogs. [1][2][3][4][5][6][7][8] In these cases, pneumocephalus occurred 1-10 weeks following cranial surgery (rhinotomy (with or without meningoencephalitis) 1 8 or transfrontal craniectomy 2-4 7 ), or 3 weeks to 15 months following skull fracture. 5 6 In human beings, 'spontaneous non-traumatic pneumocephalus' refers to pneumocephalus unassociated with recent trauma or iatrogenic procedures.…”

Delayed asymptomatic progressive intraventricular pneumocephalus in a dog following craniotomy

“…) and craniofacial trauma (n=2; Thieman et al . ,Haley & Abramson ). In all reported cases, there was concomitant neurological deterioration, and surgery to address the presumed cause of pneumocephalus was performed in seven cases, with medical treatment for concurrent meningitis in one case (Fletcher et al .…”

Invasion of fat into the brain case in a cat

“…In the veterinary literature, pneumocephalus has been reported secondary to trauma and craniotomy (Garosi and others 2002, Fletcher and others 2006, Cavanaugh and others 2008, Thieman and others 2008, Haley and Abramson 2009). In these cases, the animals had clinical signs secondary to pneumocephalus that resolved once the underlying problem was surgically corrected.…”