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

The case of 37-year old man is reported who had traumatic amputation of the right forearm together with brachial plexus and cervical roots and third right rib fracture without pneumothorax. Due to a large damage of the limb replantation was dropped and only surgical elaboration of the wound was made. A few hours after the operation, dyspnoe and headache appeared. New x-ray picture showed right pneumothorax and pneumocephalus with continuing air shadow in cervical vertebral canal. In our opinion the air from pleura might go through cervical intramuscular space to the holes in dura after avulsed roots causing pneumocephalus.
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PMID:[The traumatic amputation of the forearm complicated by pneumocephalus]. 974 97

Since the publication by F. Vourc'h in 1963 [Br J Anaesth (1963) 35:118-120] describing the use of a plastic catheter inserted percutaneously for the drainage of lumbar cerebrospinal fluid (CSF) the indications for spinal drainage are numerous, but not very well systematized. The bibliographical review shows few recent papers concerning the techniques, indications, complications and pitfalls. The authors considered it interesting to analyze nine papers, in particular those dedicated to the use of spinal drainage in skull base surgery and in the prevention and/or treatment of CSF fistulas. Two papers describe for the first time pachymeningeal gadolinium enhancement associated with orthostatic headaches, owing to CSF hypotension mimicking an inflammatory or infiltrative disease. The results of the treatment of CSF fistulas are good with a high success rate, avoiding direct surgical repair. The use of a specially designed subarachnoid catheter is clearly superior to the epidural catheter, with good flow of CSF and minimal complications. The main problems are deficient flow and infections. Overdrainage is potentially dangerous, with acute pneumocephalus, brain collapse and neurological deterioration. Infrequent but possible is Chiari II-like syndrome with vocal cord paralysis and life-threatening aspiration, or temporal downward herniation with kinking of the posterior cerebral artery and acute brain infarct. The key to success lies in a rigid protocol, intermittent CSF drainage with a closed circuit, and daily biochemical and microbiological monitoring. Highly qualified medical and nursing staff are essential.
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PMID:Cerebrospinal fluid spinal lumbar drainage: indications, technical tips, and pitfalls. 993 64

This case presentation will review tension pneumocephalus as a rare etiology of delayed posttraumatic headache (PTHA). It demonstrates that clinicians must be aware of even the uncommon causes of PTHA if appropriate diagnostic assessment and treatment are to be rendered. The case involves a 26-year-old right-handed white male who was 4 years post severe traumatic brain injury with facial fractures and an initial Glasgow Coma Scale score of 5. The patient's main postinjury functional impairments were cognitive-behavioral dysfunction, dysmetria, left hemiparesis, and posttraumatic epilepsy. Approximately 3 years post injury, the patient started to have complaints of right unilateral frontal headache. This complaint was addressed conservatively by several treating physicians. Due to the progressive nature of the patient's complaints, a second opinion was obtained with the author. On assessment, the patient complained of unilateral right headache and described the pain as making him feel as if his head was going to "bust open." A computed tomography (CT) scan showed findings consistent with a tension pneumocephalus. The patient was referred to neurosurgery, at which time the tension pneumocephalus was evacuated and a dural leak, felt to be responsible for the condition, patched. The patient's headache complaints resolved postoperatively. Clinicians should be aware of uncommon conditions that may be present in patients presenting with late PTHA, particularly conditions such as tension pneumocephalus which may have a significant clinical morbidity.
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PMID:Posttraumatic tension pneumocephalus. 994 48

A 35-year-old female suffered sudden onset of severe headache upon blowing her nose. No rhinorrhea or signs of meningeal irritation were noted. Computed tomography (CT) with bone windows clearly delineated a bony mass in the right ethmoid sinus, extending into the orbit and intracranially. Conventional CT demonstrated multiple air bubbles in the cisterns and around the mass in the right frontal skull base, suggesting that the mass was associated with entry of the air bubbles into the cranial cavity. T1- and T2-weighted magnetic resonance (MR) imaging showed a low-signal lesion that appeared to be an osteoma but did not show any air bubbles. Through a wide bilateral frontal craniotomy, the cauliflower-like osteoma was found to be protruding intracranially through the skull base and the overlying dura mater. The osteoma was removed, and the dural defect was covered with a fascia graft. Histological examination confirmed that the lesion was an osteoma. The operative procedure resolved the problem of air entry. CT is superior to MR imaging for diagnosing pneumocephalus, by providing a better assessment of bony destruction and better detection of small amounts of intracranial air.
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PMID:Pneumocephalus associated with ethmoidal sinus osteoma--case report. 1006 63

Pneumocephalus or air within the cranial vault is usually associated with disruption of the skull caused by head trauma, neoplasms, or after craniofacial surgical interventions. We report a child who presented with headache and the pathognomonic "succussion splash" and was found to have atraumatic pneumocephalus from forceful valsalva maneuvers. Pneumocephalus forms, caused by either a ball-valve mechanism that allows air to enter but not exit the cranial vault, or cerebrospinal fluid (CSF) leaks, which create a negative pressure with subsequent air entry. We review the literature for traumatic and atraumatic causes of pneumocephalus, its complications, and therapy.
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PMID:Atraumatic pneumocephalus: a case report and review of the literature. 1022 80

A 61-year-old male fell from a position 1 m high when building a house. An iron rod, which protruded upward from a solid base in cement, penetrated this patient's neck 15 cm to the head and was successfully extracted by himself. On admission, he complained of headache and vomiting. General examination disclosed nasal bleeding, intraoral bleeding, and L figured skin laceration in the left side of his neck at the level of the thyroid cartilage. Mild disorientation (JCS2) was noted. Otolaryngological examination disclosed hyperemia on the left side of the vocal cord as well as at the dome of the superior pharynx. Plain skull film disclosed pneumocephalus and that a piece of bone fragment of the planum sphenoidale had penetrated the brain. CT demonstrated air in the subarachnoid space, ventricular hemorrhage, intracerebral hematoma in the right frontal lobe, and subarachnoid hemorrhage in the anterior interhemispheric fissure. CAG detected neither cerebral vascular abnormalities nor cerebral aneurysm. While staying in our department, he developed mild fever and CSF rhinorrhea. The diagnosis of bacterial meningitis was made from the CSF finding and was well controlled with conservative therapy. CSF rhinorrhea stopped spontaneously with conservative treatment. Sagittal MRI continuously demonstrated contusional hematoma in the base of the right frontal lobe just above the fractured planum sphenoidale and genu of the corpus callosum following the course of the intracranially invading iron rod. The right CAG on Day 10 demonstrated vasospasm on the A1 and a 1 cm sized saccular cerebral aneurysm at the proximal right fronto-polar artery. CAG on Day 17 again showed the persistent presence of the aneurysm. For the purpose of preventing delayed rupture of the aneurysm, radical surgical treatment was planned. Microsurgical dissection disclosed that the aneurysm was located just behind the elevated fracture of the planum sphenoidale. Severe arachnoid adhesion was noted around the aneurysm. The aneurysm was successfully clipped with preservation of the parent artery without inducing new neurological deficits. From the general, otolaryngological, neuroradiological, and operative findings, this aneurysm was diagnosed as a traumatic cerebral artery aneurysm following the penetration of the skull base by the iron rod. The CAG performed at 8 months postoperatively demonstrated the patency of the parent artery and that there was no recurrence of the aneurysm. An unusual case of a traumatic cerebral artery aneurysm following the penetration of the skull base by an iron rod was thus reported.
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PMID:[A case of a traumatic anterior cerebral artery aneurysm following the penetration of the skull base by an iron rod]. 1039 43

We present the case history of a 23-year-old man who underwent frontal craniotomy followed by radiotherapy for a Grade III anaplastic glioma. Magnetic resonance imaging (MRI) at the 3-month follow-up showed significant tumour response. He became unwell some weeks after the MRI with an upper respiratory tract infection, severe headache and mild right-sided weakness. A computed tomographic (CT) scan showed a very large volume of intracranial gas, thought to have entered via a defect in the frontal air sinus after craniotomy and brought to light by blowing his nose. Intracranial air is frequently present after craniotomy, but it is normally absorbed within 34 weeks. The presence of pneumocephalus on a delayed postoperative CT scan should raise the possibility of a cerebrospinal fluid (CSF) fistula, or infection with a gas-forming organism. Many CSF fistulae require surgical closure in order to prevent potentially life-threatening central nervous system infection and tension pneumocephalitis. Immediate neurosurgical review is advisable.
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PMID:Gas in the cranium: an unusual case of delayed pneumocephalus following craniotomy. 1085 52

A 30-year-old female presented with headache, CSF rhinorrhoea, mild right facial weakness, 2 months following temporal lobectomy for epilepsy. CT revealed marked intraventricular pneumocephalus with breached air cells in the pneumatized lower part of temporal bone. The dural and bony defects repaired successfully with complete resolution of the pneumocephalus.
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PMID:Spontaneous cerebrospinal fluid rhinorrhoea and pneumocephalus following temporal lobectomy for epilepsy. 1127 38

We report on a 30-year-old man who was treated in the outpatient clinic for bifrontal headache for four weeks. Computed tomography showed sinusitis maxillaris, a large osteoma in the ethmoid sinus on the right side and a pneumocephalus. The surgical procedure included removal of the focus (sinusitis), extirpation of the osteoma and reconstruction of the skull base from an external approach.
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PMID:[Interesting case no. 44. Osteoma]. 1138 25

Pneumocephalus is usually caused by injury that damages the brain meninges and thus allows air to enter the intracranial cavity. Our intention was to establish the importance of considering a stab wound in the neck as a possible cause of traumatic pneumocephalus. The paper presents the case of a 13-year-old girl who was accidentally stabbed in the neck with a kitchen knife by her brother. She had no neurological deficit but had developed headaches. An examination showed cerebrospinal fluid leaking from the neck wound and a CT scan revealed the pneumocephalus. Following surgical treatment, the patient's clinical symptoms regressed. To our knowledge, this case is the first report of the manifestation of pneumocephalus as the result of a neck stab wound in a child; overall, there are only three reported cases of pneumocephalus caused by a neck stab wound.
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PMID:Pneumocephalus secondary to a neck stab wound without neurologic injury in a 13-year-old girl. 1142 73


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