Favas 1, C

Serôdio, J

Trindade, M

Acta Médica Portuguesa

English

Unidade Local de Saúde Amadora / Sintra

IMAGENS MÉDICASRevista Científica da Ordem dos Médicos www.actamedicaportuguesa.com788Spontaneous Tension PneumocephalusPneumocéfalo Espontâneo HipertensivoJoão Fernandes SERÔDIO1, Miguel TRINDADE1, Catarina FAVAS1Acta Med Port 2019 Dec;32(12):788–788  ▪  https://doi.org/10.20344/amp.115911. Serviço de Medicina IV. Hospital Prof. Doutor Fernando Fonseca. Amadora. Portugal. Autor correspondente: João Fernandes Serôdio. jserodio@campus.ul.ptRecebido: 22 de novembro de 2018 – Aceite: 21 de fevereiro de 2019 | Copyright © Ordem dos Médicos 2019Keywords: Meningitis/complications; Pneumocephalus/etiology; Pneumocephalus/therapyPalavras-chave: Meningite/complicação; Pneumocéfalo/etiologia; Pneumocéfalo/tratamentoFigure 1 – Brain CT shows large intraventricular pneumocephalus with air-fluid level, enlarged lateral ventricles and thinning of the overlying cortexA 78-year-old man was hospitalized and treated for the third episode of bacterial meningitis, with no etiologi-cal agent found. The imaging study for repeated menin-gitis revealed right tegmen tympani cerebrospinal fluid fistula. During hospitalization he developed sudden coma with no head trauma. Brain computed tomography showed large intraventricular pneumocephalus (Fig. 1). The patient underwent external ventricular drain and fistula surgical repair. The procedure was complicated by epidural hemato-ma and status epilepticus. Neurological evolution was poor.Tension pneumocephalus is defined as the presence of air within the skull leading to a rise in intracranial hyper-tension with rapid neurologic deterioration.1 Most cases occur due to face and head trauma or surgery,2 so the occurrence of spontaneous pneumocephalus is very rare.3 Spontaneous pneumocephalus in association with meningi-tis is extremely rare, is usually associated with Clostridium perfringens meningitis and rarely with mixed aerobic-anaer-obic meningitis. Management relies on surgery and sup-portive care.PROTECTION OF HUMANS AND ANIMALSThe authors declare that the procedures were followed according to the regulations established by the Clinical Research and Ethics Committee and to the Helsinki Declaration of the World Medical Association.DATA CONFIDENTIALITYThe authors declare having followed the protocols in use at their working center regarding patients’ data publication.INFORMED CONSENTObtained.CONFLICTS OF INTERESTAll authors report no conflict of interest.FUNDING SOURCESThe authors declare that there were no external sources of study for the performance of this article.REFERENCES1. Clement AR, Palaniappan D, Panigrahi RK. Tension pneumocephalus. Anesthesiology. 2017;127:710. 2. Dabdoub CB, Salas G, Silveira Edo N, Dabdoub CF. Review of the management of pneumocephalus. Surg Neurol Int. 2015;6:155. 3. Abbati SG, Torino RR. Spontaneous intraparenchymal otogenic pneumocephalus: a case report and review of literature. Surg Neurol Int. 2012;3:32.4. Kim KS, Kim SW, Kim SH. Spontaneous pneumocephalus caused by pneumococcal meningitis. J Korean Neurosurg Soc. 2013;53:249–251.5. Young M, Putty M, Schaible K. Spontaneous intraventricular tension pneumocephalus: case report and review of the literature. World Neurosurg. 2018;114:317–22.

Pneumocéfalo Espontâneo Hipertensivo

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Pneumocéfalo Espontâneo Hipertensivo

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Unidade Local de Saúde Amadora / Sintra