Tension pneumocephalus: an unusual complication after lung resection

Abstract

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.

A Case of Broncho-Paraspinal Fistula Induced by Metallic Devices: Delayed Complication of Thoracic Spinal Surgery

“…We searched PubMed and found some case reports of pneumocephalus/pneumorrhachis due to a CSF fistula that was associated with surgery. Various types of surgery were reported, but majority were lung resection 3,5,6) and the spinal surgery 4,7,9,11) . In almost all reported cases, the intervals between surgery and the development of pneumocephalus/pneumorrhachis were relatively short, from a few days 5,7,9,11) to a few months 3,4) , but the few cases of several years after the surgery were also reported 6,10) .…”

An unusual cause of acute headache: subarachnoid free air secondary to spontaneous bronchopleurodurosubarachnoid fistula from a Pancoast tumor

“…Tension pneumocephalus secondary to communication between an air-containing space and cerebral spinal fluid spaces has been described after thoracic surgery and trauma. Conservative treatment with recumbent head-down positioning has been successful in resolving symptoms [6], [8]. Increasing inspired oxygen concentration may reduce the volume of gas collection by driving nitrogen into soluble form; similarly, inhaled nitrous oxide should be avoided to prevent expansion of the gas collections, which could increase intracranial pressure [1].…”

“…A rare cause is bronchopleurodurosubarachnoid fistula, an unusual and difficult clinical problem with limited case reports, commonly related to trauma or posterolateral thoracotomies [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. We present a case of symptomatic pneumocephalus and pneumorrhachis caused by spontaneous nonsurgical, nontraumatic bronchopleurodurosubarachnoid fistula from a Pancoast tumor invading the spine after palliative chemoradiation.…”

Case Report: Pneumocephalus after labor epidural anesthesia

“…Nitrous oxide should be avoided to prevent the expansion of PC 39 . In addition, we should administer aggressive hydration, caffeine, or analgesics 40, 41 . Epidural infusion or blood patch have no effect on PC 3, 19 .…”