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Atraumatic pneumocephalus: a case report and review of the literature
F E Babl1, A M Arnett, E Barnett
1Department of Pediatrics, Boston University School of Medicine, Massachusetts, USA.
Insights
A child developed pneumocephalus (air in the skull) without trauma, caused by forceful Valsalva maneuvers. This rare condition, characterized by a "succussion splash," highlights non-traumatic causes of intracranial air.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Pneumocephalus, or air within the cranial vault, is typically linked to skull disruptions from trauma, neoplasms, or surgery.
- Understanding the mechanisms of air entry, such as ball-valve effects or cerebrospinal fluid (CSF) leaks, is crucial.
Observation:
- A pediatric case presented with headache and the distinctive "succussion splash" sign.
- Imaging revealed atraumatic pneumocephalus, suggesting an unusual etiology.
Findings:
- The patient's pneumocephalus was attributed to forceful Valsalva maneuvers, a non-traumatic cause.
- This case underscores the possibility of spontaneous air accumulation in the cranial vault.
Implications:
- Highlights the importance of considering non-traumatic etiologies for pneumocephalus.
- Suggests Valsalva maneuvers as a potential trigger for pneumocephalus in susceptible individuals.
- Emphasizes the need for thorough patient history and diagnostic evaluation for both traumatic and atraumatic causes.
Abstract:
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.