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Spontaneous otogenic pneumocephalus

Case report and review of the literature

Gregory C. Dowd, Timothy B. Molony, and Rand M. Voorhies

P neumocephalus was first described in 1741 by Lecat, as reported in a work by Jelsma and Moore. 9 In 1884 Chiari reported a fatal case of nonspontaneous pneumocephalus secondary to chronic ethmoiditis, which was later discussed by Dandy. 2 With the advent of x-ray films the ability to diagnose the presence of intracranial air improved. Luckett 10 reported a case of pneumocephalus in 1913. In 1918, Dandy, 3 a pioneer in neuroradiological imaging, proposed the intentional intracranial instillation of air to facilitate diagnostic pneumoencephalography. He

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Lawrence H. Pitts, Charles B. Wilson, Herbert H. Dedo, and Robert Weyand

I n 1884, Chiari 3 reported the first autopsied case of intracranial pneumocephalus resulting from ethmoiditis. Radiographic evidence of pneumocephalus in a patient with a skull fracture was first presented by Luckett 7 in 1913. Since then, many cases of pneumocephalus have been recognized, and at least 350 have been reported. Pneumocephalus following a ventriculoperitoneal (VP) shunt for communicating hydrocephalus has not previously been described. We are reporting such a case. Case Report At the age of 8 years, this patient underwent resection of a

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John R. Ruge, Leonard J. Cerullo, and David G. McLone

P neumocephalus was first described in 1884 by Chiari 2 as an autopsy finding in a patient who died of ethmoiditis. Luckett 17 was the first to make the roentgenographic diagnosis of pneumocephalus in 1913. Since then, more than 370 such cases have been described. Between 1914 and 1918, there were frequent reports of pneumocephalus secondary to war injuries. Indeed, the majority of cases of pneumocephalus are caused by trauma. 18 In 1962, pneumocephalus was reported by Kessler and Stern 12 as a complication of cerebrospinal fluid (CSF) shunting in a

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Todd P. Thompson, Elad Levy, Emanuel Kanal, and L. Dade Lunsford

T he presence of pneumocephalus (“air in the head”) in a patient without a history of undergoing intracranial or intrathecal procedures is a significant radiographic finding that portends a violation of the dural barrier or the presence of infection. When unexplained pneumocephalus is visualized on computerized tomography (CT) scanning, a thorough search for its cause must be pursued. We describe a case of iatrogenic intravascular pneumocephalus that confounded the evaluation and treatment of a patient. To determine the incidence of this radiographic finding, we

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Pankaj A. Gore, Harvinder Maan, Steve Chang, Alan M. Pitt, Robert F. Spetzler, and Peter Nakaji

P ostoperative pneumocephalus is an inevitable result of a craniotomy. Reasoner and colleagues 9 reported that 66% of postcraniotomy CT scans demonstrated 5–10% of intracranial volume occupied by air on at least 1 axial CT section. Although typically asymptomatic in patients, pneumocephalus of sufficient volume has been implicated in postoperative lethargy, headaches, confusion, hemiparesis, and abducens nerve palsy. 7 , 11 In rare circumstances when N 2 O is used for anesthesia in subsequent nonintracranial procedures or in discharged patients who

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John R. Little and Collin S. MacCarty

P neumocephalus occurs most commonly as the result of head trauma. However, it has been described with cranial and intracranial neoplasms and infections and after intracranial and paranasal sinus surgery. 1, 2, 6 This report describes a case of chronic symptomatic pneumocephalus that appeared to be induced by a ventriculoperitoneal shunt. Case Report This 22-year-old college graduate presented with a 1-year history of “watery” drainage from his left nostril. The onset was not related to head trauma or any other event. The drainage was constant and was

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Yusuke Ishiwata, Kazuhiko Fujitsu, Tsunemi Sekino, Hideyo Fujino, Takamichi Kubokura, Kyoji Tsubone, and Takeo Kuwabara

I ntracranial air is often seen after operations for chronic subdural hematoma (SDH), but there is seldom enough mass effect to cause neurological deterioration. Although subdural tension pneumocephalus has been reported in increasing numbers of cases since the advent of computerized tomography (CT) scanning, there are only a few reports in which the CT findings are discussed in relation to the mechanism of increased tension of the subdural air. 1, 5, 9, 10 To make a diagnosis of subdural tension pneumocephalus, increased tension of the subdural air must be

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Mont J. Cartwright and Mark B. Eisenberg

Tension pneumocephalus refers to pathological intracranial air under increased pressure. 1, 5, 6, 16, 17 It can arise whenever a ball-valve mechanism exists within an aberrant intracranial air cavity communication. The intracranial contents act as a one-way valve, allowing air to enter into but not escape from the intracranial compartment. 2, 10 Symptoms and signs, such as headache, nausea, vomiting, and a decreased level of consciousness, 2 frequently reflect an increase in intracranial pressure (ICP). An unusual case of tension pneumocephalus associated with

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James T. Stuntz and Robert M. Shuman

P erforation of various organs has been described as a complication of ventriculoatrial and ventriculoperitoneal shunts. 3–8 Occlusion of the superior vena cava is not rare; 3, 7 formation of a fistulous connection between brain and bronchus via the shunt tube is rare. 4, 6 Pneumocephalus secondary to the cerebrobronchial fistula has not been previously described. Case Report This moderately retarded 3¼-year-old girl was admitted after outpatient treatment for 1 month. She was suffering from fever, cough, tachypnea, and bilateral lingular infiltrates

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Youichi Saitoh, Noriaki Takeda, Rie Yagi, Kazuo Oshima, Takeshi Kubo, and Toshiki Yoshimine

tomography and magnetic resonance imaging revealed epidural pneumocephalus in the right middle fossa and no residual AVM. Later that month, a repeated craniotomy revealed air leakage around the bone wax. The fistula was closed using a muscle fragment. Postoperatively, the patient's pulsatile tinnitus ceased and her pneumocephalus disappeared. Pulsatile tinnitus can have a vascular or a nonvascular cause. 1, 2, 4 Among nonvascular causes of pulsatile tinnitus, palatal myoclonus has been reported to induce pulsatile movement of the tympanic membrane that is not synchronous