Intraventricular pneumocephalus associated with nasocephalic necrosis in a puppy: a case report

J.O Sena,P.M Costa,K.C.R Costa,J.F Silva,F.G Miranda,R.C.S Tôrres

doi:10.1590/1678-4162-8913

Abstract

ABSTRACT Pneumocephalus is defined as the presence of air in any of the intracranial compartments. Its most frequent causes are trauma and cranial surgery. Clinical signs occur as a result of increased intracranial pressure and vary with the location and extent of the lesion. A case involving a seven-month-old female Saint Bernard, who suffered cranial trauma caused by a bite to the face at ten days of age and had presented with seizures and localized pain four months previously is reported. A computed tomography scan of the skull revealed a nasocephalic mass with low contrast enhancement, bone lysis, and hypodensity (-940 Hounsfield units) of the lateral and third ventricles, indicating intraventricular pneumocephalus. During surgery, a fragment of the mass was collected for histopathological examination, which demonstrated the presence of multifocal areas of necrosis. The computed tomography (CT) is a reliable method for the characterization of intracranial lesions and diagnosis of pneumocephalus, whose occurrence must be considered in pathological processes in which there is increased intracranial pressure and in patients undergoing certain surgical procedures and anesthetic specific, and CT is indicated as a monitoring tool for these patients.

Highlights

Pneumocephalus, known as intracerebral aerocele or pneumatocele, is defined as the presence of air in any of the intracranial compartments. It usually occurs after cranial trauma or neurosurgical procedures, it may result from gas produced by bacteria during infection, mucoceles, congenital neurenteric cysts, and dural defects (Schirmer et al, 2010; Pereira et al, 2011)
A case of pneumocephalus that developed in a seven-month-old Saint Bernard dog and was associated with areas of intranasal necrosis invading the frontal lobes and olfactory bulbs is described
It is likely that the intranasal bacterial infection detected was secondary and probably due to a bacterial contaminant in the culture plate, since the bacteria isolated was Staphylococcus intermedius, which belongs to the nasal microbiota

Summary

INTRODUCTION

Pneumocephalus, known as intracerebral aerocele or pneumatocele, is defined as the presence of air in any of the intracranial compartments (ventricular, parenchymal, subarachnoid, or subdural compartments). A case of pneumocephalus that developed in a seven-month-old Saint Bernard dog and was associated with areas of intranasal necrosis invading the frontal lobes and olfactory bulbs is described. When the dog was clinically stable, a second tomographic examination was performed in order to assess the progress of the lesion and determine the best clinical and/or surgical treatment, taking into account potential prosencephalic compression and close contact with the nervous tissue. This second CT examination of the nasal cavity and brain revealed the presence of an intranasal mass starting near the upper right canine tooth, with a density of 30–40 HU. The patient died around five hours after the procedure and its owners did not allow a necropsy

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