Intracranial Pneumocœle

Horowitz, Melanie A.

doi:10.1017/s0022215100061910

Cited by 93 publications

(28 citation statements)

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“…Two mechanisms have been proposed to explain pneumocephalus. [17181920] In the first mechanism, the pathophysiologic process starts with CSF leak in the presence of associated discontinuity of the cranium and leptomeningeal disruption. Subsequent development of relative negative ICP results in a sufficient “vacuum effect” to cause additional accumulation of air within the cranial cavity.…”

Section: Discussionmentioning

confidence: 99%

“…Here, the positive endotympanic pressure exceeds the ICP, and air is forced from paranasal sinuses into the cranial cavity. [18] When the ICP exceeds the pressure within the air collection, the “one-way valve” closes, thus preventing the egress of the trapped air. [1920] In this mechanism, the abnormal air is usually distributed in the extradural space.…”

Section: Discussionmentioning

confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…This was described by Horowitz. Negative intracranial pressure, as can be caused by neurosurgical intervention or a Valsalva manoeuvre, can force air into the intracranial cavity when a fracture or fistula exists [8]. …”

Section: Discussionmentioning

confidence: 99%

Tension Pneumocephalus Following Bilateral Craniotomies

Coughlan

Lam

Honeybul

2017

Cureus

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Pneumocephalus is defined as a collection of air within the cranial cavity. It is a common finding following head injury with skull base fracture and neurosurgical procedures. Tension pneumocephalus is a rare complication. The diagnosis is clinical and radiological with the characteristic Mount Fuji sign seen on computed tomography (CT). It is a neurosurgical emergency, and early recognition and treatment are vital.

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“…When extracranial and/or nasopharyngeal pressure is altered, as occurs during coughing or sneezing, air may be pushed intracranially through this kind of dural defect [4, 6]. In 1964, Horowitz described the “inverted soda bottle effect,” which postulates that negative intracranial pressure created by a CSF leak may draw air into the intracranial cavity, as the air replaces the lost fluid volume via a pressure gradient between the extracranial and intracranial compartments [1, 6, 7, 10, 11]. Another contributing factor may include the thermal expansion of air by body heat, which increases the volume of air that remains in the cranial cavity [7].…”

Section: Discussionmentioning

confidence: 99%

Delayed Tension Pneumocephalus following Gunshot Wound to the Head: A Case Report and Review of the Literature

Wang

Solli

Carberry

et al. 2016

Case Reports in Surgery

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Tension pneumocephalus is a rare complication of head trauma and neurosurgical procedures, amongst other causes. It is defined by the combination of intracranial air, increased intracranial pressure, and mass effect. Although it often presents soon after surgery, it can also rarely present in a delayed fashion. We present a case of delayed tension pneumocephalus, occurring approximately 16 weeks after bifrontal craniectomy for a self-inflicted gunshot wound. Following a month of rhinorrhea, postnasal drip, and cough, the patient presented with a sensation of expansion in the area of the right forehead. As tension pneumocephalus is an emergency that can be fatal, this patient was treated expediently and avoided severe neurological deficits. The case recounted here is important as a demonstrative example that tension pneumocephalus does not always follow a defined course immediately after trauma or neurosurgery but rather can develop insidiously without obvious signs.

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Intracranial Pneumocœle

Cited by 93 publications

References 1 publication

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Tension Pneumocephalus Following Bilateral Craniotomies

Delayed Tension Pneumocephalus following Gunshot Wound to the Head: A Case Report and Review of the Literature

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