Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report

BACKGROUND

Pneumocephalus is the presence of air in the cranial cavity. When this intracranial air causes increased intracranial pressure and leads to neurological deterioration, it is known as tension pneumocephalus (TP). TP can be a major life-threatening postoperative complication, especially after evacuation of chronic subdural hematoma. We report a case of TP after evacuation of chronic subdural hematoma and review the literature.

CASE DESCRIPTION

A 70-year-old man developed right-sided weakness after being admitted with minor head trauma a few weeks earlier. He was found to have a chronic subdural hematoma and underwent burr-hole evacuation. On day 3, he suddenly deteriorated and needed intubation and ventilation. Computerized tomography (CT) of the brain showed typical Mount Fuji's sign due to TP. Immediately, 20-30 mL of air was aspirated from the intracranial fossa, and a catheter drain was inserted. The patient became fully awake after few hours and was extubated successfully. The drain was removed on day 5, and he was transferred to the ward before being discharged home.

CONCLUSION

TP after evacuation of a chronic subdural hematoma is a neurosurgical emergency and needs immediate resuscitation and therapy; hence it is of vital importance that all acute-care physicians, intensivists and neurosurgeons be aware of this clinical emergency.

Mount Fuji sign with concavo-convex appearance of epidural haematoma in a patient with tension pneumocephalus

Intracranial pneumatocele is a non-infected accumulation of air within the cranial cavity. We report a case of a 22-year-old male who sustained a fracture of anterior cranial fossa following a motor vehicle accident and the imaging findings showed a concave-convex epidural haematoma. Simple traumatic pneumocephalus usually does not require surgical treatment and non-operative management has been advocated for small, asymptomatic convexity extradural haematomas.

Pneumocephalus and meningitis as a complication of acute otitis media: case report

Otogenic pneumocephalus is a rare condition. The case is described of pneumocephalus and meningitis secondary to acute otitis media. Although the rate of intracranial complications related to middle ear disease is only 0.5 to 4%, mortality still ranges between 5 and 15%.

Intra-parenchyma Pneumocephalus: a Complication of Cochlear Implant

OBJECTIVE

We report an extremely rare case of pneumocephalus after cochlear implantation.

METHOD

Case report and a review of the world literature on pneumocephalus after cochlear implantation.

RESULTS

We present a case of uneventful cochlear implantation in a patient with nasal polyposis. Post-operative nose blowing resulted in subcutaneous emphysema pneumocephale presenting five weeks post surgery. This resolved on conservative therapy, and the patient went on to use her implant successfully.

CONCLUSION

To our knowledge this is the first report in the world literature of delayed onset as well as asymptomatic pneumocephalus after cochlear implantation.