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Case Report
Central nervous system air pressure: A tension dilemma
1 Doctoral student, Postgraduate Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
2 Intensive Care Unit, Walter Cantídio Federal Hospital, Fortaleza, Ceará, Brazil
3 Undergraduate Medicine student, Federal University of Ceará, Fortaleza, Ceará, Brazil
4 Department of Neurosurgery, Hospital São Camilo Cura D'ars, Fortaleza, Ceará, Brazil
5 Postgraduate Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
Address correspondence to:
Diego Bastos Porto
757, Pinto Madeira St., Fortaleza, Ceará,
Brazil
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Article ID: 101298Z01DP2022
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How to cite this article
Porto DB, Beltrão BA, Lima JPB, de Carvalho Filho FFL, Bandeira LAB, Boniatti MM. Central nervous system air pressure: A tension dilemma. Int J Case Rep Images 2022;13:101298Z01DP2022.ABSTRACT
Introduction: Tension pneumocephalus may lead to an increase in intracranial pressure and rapid neurologic deterioration and death. Therefore, this condition should be approached as a neurosurgical emergency.
Case Report: A 34-year-old male was admitted for resection of a relapsed meningioma. At the time, the patient complained of bilateral visual loss and intense headaches. A transsphenoidal approach was performed and the tumor’s left portion was completely resected. The tumor’s right portion was adhered to the ipsilateral carotid artery and optic nerve structures. Its complete removal was unachievable. In the next days, he experienced multiple complications such as worsening amaurosis, vascular thrombosis, and a tension pneumocephalus was diagnosed on a computed tomography (CT) scan after physical exam showed signs of elevated intracranial pressure. He underwent an urgent external ventricular derivation and, the next days, multiple interventions were deemed necessary due to a recrudescent pneumocephalus and ventricle. The patient’s Intensive Care Unit (ICU) stay went on with infectious and metabolic complications until a control head CT showed diffuse edema, with loss of cortical differentiation. Due to lack of improvement, despite best efforts, after a multidisciplinary discussion, exclusive palliative care was instituted, and the patient died shortly afterward.
Conclusion: Our case illustrates a rare occurrence of persistent tension pneumocephalus in which multiple interventions were made in order to improve outcomes. Our description demonstrates that further discussion and research regarding the optimized treatment to recurrent tension pneumocephalus is needed, in spite of its rarity.
Keywords: Brain injuries, Intraventricular air accumulation, Pneumocephalus, Tension pneumocephalus, Tension pneumoventricle
SUPPORTING INFORMATION
Author Contributions
Diego Bastos Porto - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Beatriz Amorim Beltrão - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
João Pedro Barros Lima - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Francisco Flávio Lei de Carvalho Filho - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Luiz Anderson Bevilaqua Bandeira - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Marcio Manozzo Boniatti - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Diego Bastos Porto et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
