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Pneumocephalus and pneumococcal meningitis after thoracic surgery
Sandra Asner1, Caroline Chapuis-Taillard, Hans-Beat Ris
1Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Asian Cardiovascular & Thoracic Annals
|November 22, 2011
Summary
A rare complication of chest wall resection, a subarachnoid-pleural fistula, led to pneumocephalus and meningitis. Prompt surgical and antibiotic treatment successfully resolved the neurological deterioration.
Area of Science:
- Neurosurgery
- Thoracic Surgery
- Infectious Disease
Background:
- A 62-year-old male patient with adenocarcinoma underwent a complex surgical procedure involving right upper lobectomy and en-bloc chest wall resection.
- Metallic clips were applied to the vertebral nerve roots during the surgery.
Observation:
- The patient experienced a sudden decline in neurological function post-operatively.
- This deterioration was attributed to pneumocephalus (air in the cranial cavity) and ascending bacterial meningitis.
Findings:
- A subarachnoid-pleural fistula was identified as the cause of the pneumocephalus and meningitis.
- Neurological status improved significantly following a thoracoplasty (surgical procedure to collapse the chest cavity) and administration of ceftriaxone (an antibiotic).
Implications:
- This case highlights a rare but serious complication following thoracic surgery involving the chest wall and spine.
- Early recognition and combined surgical and antimicrobial management are crucial for favorable outcomes in such cases.
- Emphasizes the importance of meticulous surgical technique to prevent cerebrospinal fluid leaks and subsequent infections.
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