Traumatic Subdural Pneumocephalus Causing Rise in Intracranial Pressure in the Early Phase of Head Trauma: Report of two Cases

Öge, Kamil; Akpınar, Gökhan; Bertan, Vural

doi:10.1007/s007010050159

Cited by 15 publications

(8 citation statements)

References 6 publications

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“…[610] Among these pathophysiologic entities, craniofacial trauma is the most common etiologic factor, with as many as 7%–9% of patients in that group demonstrating the presence of intracranial air on advanced (CT) imaging. [111213] Although the precise incidence of TP among patients with craniofacial trauma is not known, and has not been formally reported to date, the figure is likely <1% (i.e., the authors' medical institutions have seen well in excess of 300 patients with craniofacial trauma during the same year as the two reported cases). Plain imaging can diagnose pneumocephalus, but CT scan is the diagnostic modality of choice, with an ability to detect as little as 0.5 cm 3 of air.…”

Section: Discussionmentioning

confidence: 94%

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Pillai

Sharma

MacKenzie

et al. 2017

Int J Crit Illn Inj Sci

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Although traumatic pneumocephalus is not uncommon, it rarely evolves into tension pneumocephalus (TP). Characterized by the presence of increasing amounts of intracranial air and concurrent appearance or worsening neurological symptoms, TP can be devastating if not recognized and treated promptly. We present two cases of traumatic TP and a concise review of literature on this topic. Two cases of traumatic TP are presented. In addition, a literature search revealed 20 additional cases, of which 18 had sufficient information for inclusion. Literature cases were combined with the 2 reported cases and analyzed for demographics, mechanism of injury, symptoms, time to presentation (acute <72 h; delayed >72 h), diagnostic/treatment modalities, and outcomes. Twenty cases were analyzed (17 males, 3 females, median age 26, range 8–92 years). Presentation was acute in 13/20 and delayed in 7/20 patients. Injury mechanisms included motor vehicle collisions (6/20), assault/blunt trauma to the craniofacial area (5), falls (4), and motorcycle/ bicycle crashes (3). Common presentations included depressed mental status (10/20), cerebrospinal fluid rhinorrhea (9), headache (8), and loss of consciousness (6). Computed tomography (CT) was utilized in 19/20 patients. Common underlying injuries were frontal bone/sinus fracture (9/20) and ethmoid fracture (5). Intracranial hemorrhage was seen in 5/20 patients and brain contusions in 4/20 patients. Nonoperative management was utilized in 6/20 patients. Procedural approaches included craniotomy (11/20), emergency burr hole (4), endoscopy (2), and ventriculostomy (2). Most patients responded to initial treatment (19/20). One early and one delayed death were reported. Traumatic TP is rare, tends to be associated with severe craniofacial injuries, and can occur following both blunt and penetrating injury. Early recognition and high index of clinical suspicion are important. Appropriate treatment results in improvement in vast majority of cases. CT scan is the diagnostic modality of choice for TP.Republished with permission from:Pillai P, Sharma R, MacKenzie L, Reilly EF, Beery II PR, Papadimos TJ, Stawicki SPA. Traumatic tension pneumocephalus: Two cases and comprehensive review of literature. OPUS 12 Scientist 2010;4(1):6-11.

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Section: Discussionmentioning

confidence: 94%

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Pillai

Sharma

MacKenzie

et al. 2017

Int J Crit Illn Inj Sci

View full text Add to dashboard Cite

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“…[ 4 ] Some years later, Chiari reported a similar finding in an autopsy of a patient with chronic ethmoid sinusitis. [ 5 ] The usefulness of X-ray in diagnosing intracranial air was demonstrated by Luckett in 1913. Pneumocephalus is a complication of head injury in 3.9-9.7% cases but in our series it was 0.226%, which is very less compare to previous literature.…”

Section: Discussionmentioning

confidence: 99%

Outcome of posttraumatic delayed intracerebral tension pneumatocele: Prospective study of four cases: Single institutional experience

Kankane

Gupta

2018

Asian J Neurosurg

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Aim:Delayed intracerebral tension pneumatocele (DITP) is an uncommon cause of raised intracranial pressure following trauma. However, it can cause herniation syndrome due to a sudden increase in intracranial pressure which requires emergent intervention. Pneumocephalus is a complication of head injury in 3.9%–9.7% of the cases. The accumulation of intracranial air can be acute (<72 h) or delayed (≥72 h).Method:When intracranial air causes intracranial hypertension and has a mass effect with neurological deterioration, it is called tension pneumocephalus. In our case series, we demonstrated four cases of DITP in adult patients from January 2012 to January 2017 in the Department of Neurosurgery at R. N. T. Medical College and M. B. Hospital, Udaipur, Rajasthan.Result:During this period, a total number of patients admitted of head injury are 1768 and hence, the incidence of DITP in our series is 0.226% which is very less as compared to previous literature. All patients are male; age ranging from 17 years to 55 years (mean age was 31.75 years). All patients have a history of head injury, and mode of injury had road traffic accidents. Glasgow Coma Score (GCS) at readmission were 12–13 (mean GCS 12.75). Duration of developed DITP 1 month to 2½ months (mean 1.375 months), all patients had gone to surgical intervention, and outcome assessed using Glasgow outcome score. All patients had a good outcome and average follow-up was 12.5 months.Conclusion:long term observation of patients with simple pneumocephalus following trauma is beneficial as there is an expected risk of developing delayed tension pneumocephalus which may manifest with raised intracranial pressure.

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“…[ 34 ] Pneumocephalus is commonly encountered after neurosurgical procedures, especially CSH drainage[ 33 35 36 37 38 39 40 41 42 ] but can also be caused by craniofacial trauma[ 43 ] and tumors of the skull base[ 40 ] and rarely can occur spontaneously. [ 44 ] Contributing factors for the development of pneumocephalus include head position, duration of surgery, nitrous oxide (N 2 O) anesthesia,[ 45 46 ] hydrocephalus, intraoperative osmotherapy, hyperventilation, spinal anesthesia, barotauma, continuous cerebrospinal fluid drainage through lumbar drain or shunting system,[ 40 47 ] epidural anesthesia, infections, dural defect after craniotomy,[ 48 ] tear of arachnoid membrane,[ 38 49 ] and neoplasms. Clinical complaints include headaches, nausea and vomiting, seizures, dizziness, and depressed neurological status.…”

Section: Discussionmentioning

confidence: 99%

Organized chronic subdural hematomas treated by large craniotomy with extended membranectomy as the initial treatment

Balevi

2017

Asian J Neurosurg

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Objective:The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH).Materials and Methods:We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance – mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24–72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH).Results:Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients (n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%.Conclusion:Large craniotomy and extended membrane excision for OSDH still carry a high rate of mortality and morbidity in elderly patients. TP, RSH, and postoperative seizures are frequently seen complications in elderly patients.

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Traumatic Subdural Pneumocephalus Causing Rise in Intracranial Pressure in the Early Phase of Head Trauma: Report of two Cases

Cited by 15 publications

References 6 publications

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Outcome of posttraumatic delayed intracerebral tension pneumatocele: Prospective study of four cases: Single institutional experience

Organized chronic subdural hematomas treated by large craniotomy with extended membranectomy as the initial treatment

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