Tension pneumoventricle: Reversible cause for aphasia

Abstract

Pneumocephalus is air in the cranium commonly seen in postcraniotomy and in head injury patients. When this air causes an increase in intracranial pressure leading to neurological deterioration, it is called tension pneumocephalus. Similarly, intraventricular air causing compression on vital centers and increasing intracranial pressure is called tension pneumoventricle, and this causes expressive aphasia, which is rarely described in the literature. This study reported a case of a traumatic cerebrospinal fluid (CSF) leak leading to tension pneumoventricle and aphasia. Case: A young male patient sustained severe head injury and had extradural hematoma (EDH) and multiple skull and skull base fractures. EDH was drained, and he recovered and was discharged with a Glasgow coma scale score of 15. He presented to neurosurgical outpatient with CSF leak, aphasia, and loss of bowel and bladder control for a duration of three days. Computed tomography brain scan showed tension pneumoventricles, and he was started on conservative management. His general condition deteriorated, and the next day, his pupils became unequal, and Glasgow coma scale (GCS) dropped to 8/15. He was immediately taken to theater, and the air was aspirated from the ventricles, and an external ventricular drain was inserted. The patient woke up in the immediate postoperative period and started talking normally by day four. Conclusion: Tension pneumoventricles should be considered a cause of aphasia. Immediate intervention and reduction of intracranial pressure are crucial to reverse neurological abnormality and improve patient's outcome.

Tension pneumoventricle in a patient with a ventriculoperitoneal shunt and an ethmoidal meningoencephalocele

“…[ 23 ] However, for significantly symptomatic patients, the placement of an EVD is usually required. [ 2 , 20 ] Patients usually show an immediate improvement. If there is a CSF fistula, treatment by completely excluding the fistula is necessary because of the lethal risk of pneumoventricle and meningitis.…”

Management and Treatment of Delayed Posttraumatic Tension Pneumoventricle in Low-Income Countries: A Report of Two Rare Cases and Literature Review

“…Posttraumatic tension pneumoventricle is an extremely rare neurosurgical emergency that occurs 72 h after head trauma. It occurs after a skull base fracture complicated by an osteodural defect without pneumocephalus or, more rarely, as a complication of a simple posttraumatic pneumoventricle [1,3,7,8]. This pathology represents a challenge in low-income countries because of limited access to social security and brain imaging and a poorly performing medical transport system.…”

Pneumocephalus following sneeze suppression

“…Simple pneumocephalus does not cause increases in intracranial pressures, whereas tension pneumocephalus does cause an increase in intracranial pressure, with potential life-threatening compression of the brainstem [3] . Tension pneumoventricle is one such life-threatening presentation, where air accumulates inside the ventricles and compresses vital respiratory center [4] . While the most common traumatic causes of pneumocephalus involve skull fractures from external forces, this case describes a unique situation where the cause is a sneeze suppression, leading to a rupture of the olfactory bulb.…”