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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-four previously reported cases of otogenic pneumocephalus were analyzed in addition to five new cases which are presented in detail. Forty-one males and 18 females were included with 95% of the patients being over 12 years of age. The most common presenting symptom was headache, and the ventricular system was the intracranial space most commonly involved. Tension pneumocephalus was present in 40 (66%) cases. Trauma (36%) was the most common etiologic factor, while otitis media (30%), otologic surgery (30%), and congenital defects (2%) accounted for the rest. The overall mortality was 12% with all patients succumbing to causes other than pneumocephalus. Because of its lack of specific symptoms, pneumocephalus was usually unsuspected and the diagnosis made only after radiographic evaluation. Despite its rarity, pneumocephalus has to be considered whenever the dura is violated, especially if associated with a CSF leak. Management depends on the degree of tension, symptomatology, and underlying cause. When associated with trauma or surgery, bedrest and close monitoring may suffice, although needle aspiration or re-exploration may be needed. When secondary to otitis media or a congenital defect, control of any infection and repair of the defect are mandatory.
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PMID:Otogenic pneumocephalus. 370 68

Three cases of tension pneumocephalus are reported and pathogenesis, clinical features and management of this complication is discussed. Case 1: A 12-year-old female underwent a craniotomy for a suprasellar tumor following V-P shunting. At that time, Mayfield's pin fixing head holder was used and a CSF leak from a puncture wound caused by the head holder was noted postoperatively. Although she showed uneventful recovery from the anesthesia, several hours after surgery, she developed general convulsions and deteriorated. CT scan revealed a huge bifrontal accumulation of air compressing the entire brain postero-caudally. No active measures were taken to treat the intracranial air and a follow-up CT scan revealed a hemorrhagic infarction in the right occipital lobe possibly caused by transtentorial herniation. The patient remained in a vegetative state until her death three years later. Case 2: A 55-year-old man had a pansinectomy for sinusitis. Seven days later he developed CSF rhinorrhea and a severe headache. A CT scan revealed air in the subarachnoid space as well as in the ventricles. After repeated spinal taps, he became stuporous. An emergency repair of the CSF leak was performed. Intraoperatively, the accumulation of air was noted in the subarachnoid space under extreme tension. He made a full recovery. Case 3: A 69-year-old woman underwent a neck clipping for a ruptured anterior communicating aneurysm 2 days after the onset. Shortly before the craniotomy, a continuous spinal drainage system was installed. Postoperatively she did not recover from the anesthesia and a CT scan showed an accumulation of air in the bifrontal subdural space compressing the brain posteriorly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative tension pneumocephalus--report of 3 cases]. 374 94

The authors present two cases of pneumocephalus occurring in patients with permanent shunts and review nine previously reported cases. Mental status changes and headache are the most common presenting symptoms. Six of the 11 cases of pneumocephalus occurred in patients with shunt placement for hydrocephalus secondary to aqueductal stenosis. In these patients, thinned cerebrospinal fluid barriers secondary to long-standing increased intracranial pressure may predispose them to pneumocephalus. Temporary extraventricular drainage is an effective method of treatment in this group of patients. Two other etiologies are identified with significance to treatment, and the role of craniotomy is discussed.
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PMID:Pneumocephalus in patients with CSF shunts. 403 17

A 60 year old male had an open thoracotomy for bronchogenic carcinoma. On the twelfth hospital day he became obtunded and complained of headache. Radiographs revealed intracranial air. It was thought that the pneumocephalus in this patient was most likely secondary to a tension pneumothorax continuously forcing air through a dural tear sustained at the time of initial surgery. The causes of pneumocephalus are reviewed and no similar case report has been found in the literature.
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PMID:Pneumocephalus: an unusual cause. 482 33

The authors reported a case of pneumocephalus induced by bromocriptine (Bc) treatment for a recurrent invasive prolactinoma. The patient was a 38-year old man, who had been treated for 12 years, with three times of craniotomies and two times of irradiation therapies. CT scan showed the recurrence of the tumor, which extended into bilateral middle fossa, left orbit and left cerebellopontine angle. Serum prolactin levels elevated to 35,200 ng/ml. Then Bc was administered in a dose of 5 mg/day. Serum PRL concentration fell to 2,090 ng/ml one month after the initiation of the treatment, when he complained of headache, nausea and vomiting. Since these symptoms were considered as the side effects of Bc, the dose was reduced to 2.5 mg/day. Three weeks later, plain craniograms showed marked pneumocephalus, while no tumor was found on CT scan. The administration of Bc was stopped and he was prescribed a complete rest for a month. The air was collected again when he began to walk around. Therefore, the transsphenoidal operation was performed in order to pack the sella turcica and sphenoid sinus with muscle pieces. Since the pneumocephalus could not be cured, the muscle, taken from the thigh, was spread throughout the left middle fossa by the front-temporal craniotomy. When Bc reduces the size of the invasive prolactinomas, the intra- and extra-cranial spaces may be communicated. The greatest care should be taken for pneumocephalus, CSF rhinorrhea and/or meningitis during the Bc treatment of prolactinomas.
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PMID:[Pneumocephalus induced by bromocriptine treatment in male prolactinoma--a case report]. 666 17

A 19-year-old boy suffered from headache and intermittent CSF rhinorrhea, was admitted to Matsuyama Shimin Hospital on June 1, 1979. Two months prior to admission he had had a frontal head injury with confusion and the right nasal bleeding. Plain skully x-ray films and biplane (axial & coronal) CT revealed intracerebral pneumocephalus in the right frontal lobe with depressed basal skull fracture into the right ethmoid sinus. Clinical conservative courses of intermittent CSF rhinorrhea, headache and vomiting were related to the changes of the air shadow on plain skull films. Preoperative metrizamide CT Cisternography was done on July 5. Sequential CT cisternograms demonstrated ventricular reflux at 1 hr and partial obstruction of the basal cistern and supratentorial subarachnoid space at 3 hr, which attributed to the mass effect of the air cysts. They also demonstrated an interesting finding, the accumulation of metrizamide into the intracerebral air cyst at 3 hr, suggesting transependymal penetration of contrast medium. At 24 hr, the air cyst decreased in size and the metrizamide disappeared. CT cisternograms 8 months after the surgery showed no evidence of air cyst but remained a low dense porencephalic cyst. Ventricular reflux was seen at 3 and 6 hr but there was no accumulation of metrizamide into the cyst at any hr. Filling patterns of the basal cistern and supratentorial subarachnoid space returned normal except the defect in the anterior interhemispheric cistern. Transependymal penetration of metrizamide in this case can be explained by the mechanism of pressure gradient between the ventricle and the air cyst. Thus the postoperative CT cisternograms showed no penetration because of the absence of pressure gradient, whereas the ventricular reflux and the same ependymal septum still remained. No mention has been made about the CSF flow dynamics in intracerebral pneumocephalus and their relation to the CSF rhinorrhea in previous literature. Intermittent CSF rhinorrhea of this case will attribute to the CSF accumulated in the air cyst as mentioned above.
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PMID:[A case report of traumatic intracerebral pneumocephalus with interesting CT cisternographic findings (author's transl)]. 711 May 20

We report a case of pneumocephalus following the attempted treatment of a postdural puncture headache by a continuous epidural saline infusion. Within 1 hour of infusion, symptoms of a severe headache, nausea, and vomiting prompted a computerized tomographic scan of the head that showed 12 to 15 ml of air in the cranium. The epidural space was located easily with the loss-of-resistance technique using 3 ml of air. A saline bolus and infusion were initiated after confirmation of correct placement of the epidural catheter. We suggest that air passed from the negative-pressure epidural space through the dural puncture created by the diagnostic spinal tap, producing a pneumocephalus.
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PMID:Pneumocephalus following the treatment of a postdural puncture headache with an epidural saline infusion. 788 May 16

A 27-year-old female with no history of trauma, surgery, infection, or neoplastic process was evaluated for the spontaneous onset of vomiting, headache, and loss of balance. Initial studies demonstrated extensive pneumocephalus. CT revealed a lytic, expansile defect of the right petrous bone, while intrathecal contrast images demonstrated flow of CSF that implied coincidental perforation of the tympanic membrane. MR imaging demonstrated a continuity of CSF signal. The patient underwent surgery to repair the CSF leak and a dural patch was applied. No symptoms of pneumocephalus were seen after surgery and the patient's condition improved.
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PMID:Spontaneous CSF communication to the middle ear and external auditory canal. A case report. 808 63

Pneumocephalus is a rare complication of anesthetic procedures involving the epidural space. We report the case of a 36-year-old woman who developed a severe headache due to pneumocephalus that occurred during an epidural blood patching procedure. This report reviews the blood patch procedure and its attendant complications. Emergency physicians should be aware of the potential complications of this commonly performed procedure and include iatrogenic pneumocephalus in the differential diagnosis of severe headache in the proper clinical scenario.
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PMID:Pneumocephalus following an epidural blood patch procedure: an unusual cause of severe headache. 827 45

Non-traumatic otologic diseases are a rare cause of Pneumocephalus. Among them few reports have been published whereas it presented following oto-surgery. The AA. communicate one of those events in a patient who presented with CSF-otorrhea, headache and disorientation after recent radical mastoidectomy. The definitive diagnosis was done by CT-scan imaging. Survey of the scarce literature on the subject, description of the clinical and diagnostic features, its possible physiopathology and surgical management.
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PMID:[Pneumocephalus as a complication of mastoid surgery]. 829 66


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