Posttraumatic Delayed Tension Pneumocephalus: Case Report

Öz

Aim: Tension pneumocephalus is a problem that requires emergent intervention for the fact that it can lead to sudden increase in intracranial pressure. In this study we present a case of late tension pneumocephaly which threatened the life of the patient. Subject: A 63-year-old man was admitted to our emergency unit with severe headache after being involved in a traffic accident. Radiological exams showed frontal sinus fracture, frontal cerebral contusion and minimal pneumocephalus. Conservative treatment was initiated. On the eleventh day he had a disturbance in consiousness, hence another cranial computerized tomography was taken which revealed subdural, intraventricular and intraparenchymal tense air that caused high pressure on the brain and intracranial areas including the posterior fossa. The patient was operated on urgently and the tense air was evacuated. During the postoperative period the patient's state of conscious began to improve. Result: In view of this situation, although tension pneumocephaly generally develops during the early posttraumatic period, it should be kept in mind that it can also develop in the late phase. So long-term, close observation for the patients with simple pneumocephaly is beneficial. Key words: Head Trauma, Delayed Tension Pneumocephalus

Anahtar Kelimeler

• Head Trauma, Delayed Tension Pneumocephalus

Posttravmatik Gecikmiş Tansiyon Pnömosefali: Olgu Sunumu

Öz

Amaç: Tansiyon pnömosefali ani intrakranial basınç artışına neden olduğu için acil müdahale gerektiren bir patolojidir. Bu çalışmada, posttravmatik geç dönemde oluşan ve hastanın hayatını tehdit eden bir tansiyon pnömosefali olgusunun sunulması amaçlandı. Olgu: Trafik kazası nedeniyle acil polikliniğimize başvuran, giriş nörolojik muayenesi normal fakat şiddetli baş ağrısı olan 63 yaşında bir erkek hastaya yapılan BBT'de frontal sinüs fraktürü, frontal kontüzyonel kanama ve minimal pnömosefali tespit edildi. Kliniğe yatırılıp takip edilen hastanın 11. gün şuur düzeyinde gerileme olması nedeniyle yapılan BBT'de, subdural, intraventriküler ve intraparankimal basınçlı hava tespit edildi.Hava beyin dokusuna arka fossa dahil tüm intrakraniyal alanda ileri derecede bası yapıyordu. Hasta acil olarak ameliyat edilerek basınçlı hava boşaltıldı. Postoperatif hastanın şuur düzeyi açıldı. Sonuç: Tansiyon pnömosefali, genellikle erken dönem oluşmakla beraber, posttravmatik geç dönemlerde de ortaya çıkabilir. Bu nedenle basit pnömosefali bulunan hastaların uzun dönem yakın takipleri faydalıdır. Anahtar kelimeler: Gecikmiş Tansiyon Pnömosefali, Kafa Travması

Anahtar Kelimeler

• Gecikmiş Tansiyon Pnömosefali, Kafa Travması

Kaynakça

1. Osborn AG, Daines JH, Wing SD: Intracranial air on computerized tomography. Neurosurgery, 1978; 48: 355-9.
2. Markham JW: The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir (wien), 1967; 16: 1-78.
3. Altınörs N, Arda N, Kars Z, et al: Tension pneumocephalus after transsphenoidal surgery: case report. Neurosurgery, 1988; 23: 516-8.
4. Avellanal M, Olmedilla L, Ojea R, Rueda ML, Navia J: Pneumocephalus after spinal anesthesia. Anesthesiology, 1996; 85: 423-5.
5. Bremer AM, Nguyen TQ: Tension pneumocephalus after surgical treatment of chronic subdural hematoma: report of three cases. Neurosurgery, 1982; 11: 284-7.
6. Perrin RG, Bernstein M: Tension pneumoventricle after placement of a ventriculoperitoneal shunt: a novel treatment strategy. Case report.J Neurosurg, 2005; 102: 386-388.
7. Ram Z, Knoller N, Findler G, Sahar A: Delayed intravetricular tension pneumocephalus complicating posterior fossa surgery for cerebellar medulloblastoma. Child Nerv Sys, 1992; 8:351-3.
8. Gönül E, İzci A, Sali A, Baysefer A, Timurkaynak E: Subdural and intraventricular traumatic pneumocephalus: case report. Minimal Invasive Neurosurgery, 2000; 43: 98-101.

9. Candrina R, Galli G, Bollati A: Letter to the editor: subdural and intraventricular tension pneumocephalus after transsphenoidal operation. J Neurol Neurosurg Psychiatry, 1988; 23: 516-8.
10. Arbit E, Shah J, Bedford R, Carlon G: Tension pneumocephalus: treatment with controlled decompression via a closed waterseal drainage system: case report . J Neurosurg, 1991; 74: 139-142.
11. Browning CJ, Harland SP, Burnet NG: Gas in the cranium: an unusual case of delayed pneumocephalus following craniotomy. Clın Oncol (R Coll Radiol), 2000; 12: 118-120.
12. Huang CF, Chou TY, Chang CK: Traumatic tension pneumocephalus--intracerebral pneumatocele: a case report. Gaoxiong yi xue ke xue za zhi, 1992; 8: 113-116.
13. Kon T, Hondo H, Kono M, Kasahara K: Severe tension pneumocephalus caused by opening of the frontal sinus by head injury 7 years after initial craniotomy; case report. Neurol Med Chır (tokyo), 2003; 43: 242-245.