Abstract
Pneumocephalus, the presence of intracranial air, is a complication especially seen after neurotrauma or brain surgery. When it leads to a pressure gradient, a so-called tension pneumocephalus, it may require emergency surgery. Clinical symptomatology, especially in young children, does not differentiate between a pneumocephalus and a tension pneumocephalus. An additional CT scan is therefore warranted. Here, we report on a rare case of pneumocephalus after penetrating lumbar injury. Additionally, the pathophysiology of pneumocephalus, as well as its recommendations for diagnosis and treatment, will be elucidated.
Highlights
Pneumocephalus, the presence of intracranial air, is a complication especially seen after neurotrauma or brain surgery
A 6-year-old boy without relevant medical history presented at the emergency department of the Maastricht University Medical Centre (MUMC+), after referral from a local hospital
Even though pneumocephalus is frequently encountered on routine imaging after craniotomy in neurosurgical practice, a very limited number of publications about pneumocephalus is
Summary
Pneumocephalus, known as intracerebral aerocèle or pneumatocèle, is the presence of intracranial air and can be present intra- or extra-axially [14]. In Bthe ball valve mechanism,^ the mechanism of action in tension pneumocephalus, a pressure gradient arises and causes a large collection of intracranial air [2, 3]. The presence of multiple small air bubbles scattered through several cisterns and the arachnoid space is called Bair bubble sign^ [4] Not pathognomonic, both BMount Fuji sign^ and Bair bubble sign^ may indicate the development of tension pneumocephalus [2, 4, 14]. Further conservative treatment involves administration of antipyretic pain medication to prevent hyperthermia, avoidance of the Valsalva maneuver (e.g., coughing), and excessive physical activities These recommendations form an effective approach with a reduction of intracranial air in 85% of patients, within 2 or 3 weeks [8, 12]. We hypothesize an Benhanced inverted soda bottle mechanism^ to be responsible
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