Akinetic mutism and parkinsonism due to subdural and intraventricular tension pneumocephalus

Area of Science:

• Neurosurgery
• Neurology
• Medical Imaging

Background:

• Pneumocephalus, or air within the cranial cavity, is a known complication following intracranial surgery.
• It is most frequently observed after posterior fossa procedures and is typically asymptomatic.
• However, symptomatic cases, though rare, can present with significant neurological deficits.

Observation:

• A 56-year-old male presented with akinetic mutism and parkinsonism.
• These neurological deficits were attributed to subdural and intraventricular tension pneumocephalus.
• The condition arose subsequent to the decompression of a chronic subdural hygroma.

Findings:

• The patient's tension pneumocephalus was successfully managed through an emergency air-fluid exchange with saline via a drainage system.
• Following the initial intervention, a subduro-peritoneal shunt was implanted.

Implications:

• This case highlights that pneumocephalus, even after chronic subdural hygroma decompression, can manifest with severe neurological symptoms requiring urgent intervention.
• Effective management involves prompt diagnosis and appropriate surgical treatment, such as shunt placement, to relieve intracranial pressure and reverse neurological deficits.