Case report. Acute confusion secondary to pneumocephalus in an elderly patient

Abstract

Presentation: an 83-year-old man was admitted to hospital with acute confusion 3 days after a direct flight from Australia. Outcome: computed tomography (CT) brain scan and magnetic resonance imaging head scan revealed the cause to be pneumocephalus, apparently the result of barotrauma caused by Valsalva manoeuvres when he attempted to unblock his nose during the flight. After 5 days of nursing in the vertical position the patient's Abbreviated Mental Score returned to normal. A CT brain scan 6 weeks later showed complete resolution of the pneumocephalus.

Symptomatic spontaneous pneumocephalus after spinal fusion for spondylolisthesis

“…1 Spontaneous pneumocephalus has also been reported after nasotracheal intubation, bag-mask and PEEP ventilation, spinal anesthesia, and nitrous oxide anesthesia. 2 Empty sella syndrome is also a cause of spontaneous CSF rhinorrhea. 3 Dural tear and the ball-valve effect are the two mechanisms that may cause pneumocephalus.…”

Acute confusion and agitation after epidural anaesthesia: answer

“…5 It may be secondary to a life-threatening process, such as air emboli, neoplasm, infection or trauma. 8 The radiographic appearance can be mimicked by artifacts, such as scanning through a nearby trauma board, dense bone, radio-opaque foreign bodies or a stereotactic frame.…”

“…Absorption of intracranial air occurs in 85% of cases within the first week. 5 The remaining 15% are at risk of CSF infection via the dural breach which is allowing air entry. 5 Basic management of pneumocephalus is bed rest with the head of the bed elevated.…”

“…5 The remaining 15% are at risk of CSF infection via the dural breach which is allowing air entry. 5 Basic management of pneumocephalus is bed rest with the head of the bed elevated. Antibiotics should be used in pneumocephalus secondary to trauma or where there is an ongoing breach of dural integrity.…”

“…Antibiotics should be used in pneumocephalus secondary to trauma or where there is an ongoing breach of dural integrity. 5 …”