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      Posttraumatic delayed subdural tension pneumocephalus

      case-report

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          Abstract

          Background:

          Pneumocephalus is a complication of head injury in 3.9-9.7% of the cases, it also appears after supratentorial craniotomy in 100% of cases. The accumulation of intracranial air can be acute (<72 hours) or delayed (≥72 hours). When intracranial air causes intracranial hypertension and has a mass-effect with neurological deterioration, it is called tension pneumocephalus.

          Case description:

          We represent a clinical case of a 75-year-old male patient with open penetrating head injury, complicated by tension pneumocephalus on the fifth day after trauma and underwent urgent surgical correction. Operation performed: Burr-hole placement in the right frontal region, evacuation of tension pneumocephalus.

          Conclusion:

          Tension pneumocephalus is a life-threatening neurosurgical emergency case, which needs to undergo immediate surgical or conservative treatment.

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          Most cited references29

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          Tension pneumocephalus after neurosurgery in the supine position.

          Tension pneumocephalus has been reported most frequently after posterior fossa surgery performed in the sitting position. We present a paediatric patient who developed tension pneumocephalus in the postoperative period after decompression of a craniopharyngioma performed with the patient in the supine position.
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            The Mount Fuji sign.

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              Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report

              Background: Pneumocephalus is the presence of air in the cranial cavity. When this intracranial air causes increased intracranial pressure and leads to neurological deterioration, it is known as tension pneumocephalus (TP). TP can be a major life-threatening postoperative complication, especially after evacuation of chronic subdural hematoma. We report a case of TP after evacuation of chronic subdural hematoma and review the literature. Case Description: A 70-year-old man developed right-sided weakness after being admitted with minor head trauma a few weeks earlier. He was found to have a chronic subdural hematoma and underwent burr-hole evacuation. On day 3, he suddenly deteriorated and needed intubation and ventilation. Computerized tomography (CT) of the brain showed typical Mount Fuji’s sign due to TP. Immediately, 20-30 mL of air was aspirated from the intracranial fossa, and a catheter drain was inserted. The patient became fully awake after few hours and was extubated successfully. The drain was removed on day 5, and he was transferred to the ward before being discharged home. Conclusion: TP after evacuation of a chronic subdural hematoma is a neurosurgical emergency and needs immediate resuscitation and therapy; hence it is of vital importance that all acute-care physicians, intensivists and neurosurgeons be aware of this clinical emergency.
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                Author and article information

                Journal
                Surg Neurol Int
                Surg Neurol Int
                SNI
                Surgical Neurology International
                Medknow Publications & Media Pvt Ltd (India )
                2229-5097
                2152-7806
                2013
                25 March 2013
                : 4
                : 37
                Affiliations
                [1]Neurosurgical Department, Yalta City Hospital, Yalta, Crimea, Ukraine
                Author notes
                [* ]Corresponding author
                Article
                SNI-4-37
                10.4103/2152-7806.109537
                3622390
                23607059
                efdfede2-843e-43b2-a3cc-13e176f040d5
                Copyright: © 2013 Solomiichuk VO

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 January 2013
                : 05 March 2013
                Categories
                Case Report

                Surgery
                cerebrospinal fluid leak,computed tomography scan,craniofacial trauma,head injury,tension pneumocephalus

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