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Retroclival Pneumocephalus Associated with Bilateral Abducens Palsy in a Child
Aline Lariessy Campos Paiva1, Guilherme Brasileiro de Aguiar, Vinicius Riccieri Ferraz
1Neurosurgery Division, Surgery Department, Faculdade de Cix00EA;ncias Mx00E9;dicas da Santa Casa de Sx00E3;o Paulo, Sx00E3;o Paulo, Brazil.
Insights
Traumatic brain injury (TBI) in children can cause rare posterior fossa lesions. This case highlights retroclival pneumocephalus leading to sixth cranial nerve compression and bilateral abducens palsy.
Area of Science:
- Pediatric Neurosurgery
- Neurotraumatology
- Neuroradiology
Background:
- Traumatic brain injury (TBI) is less frequent in children than adults.
- Posterior fossa lesions are uncommon in pediatric TBI, often presenting as epidural hematomas.
- These lesions can cause severe outcomes due to compression of critical infratentorial structures and acute hydrocephalus.
Observation:
- A 12-year-old male with TBI presented with multiple pneumocephali.
- One pneumocephalus was located in the retroclival region, causing a mass effect.
- This retroclival pneumocephalus led to compression of the sixth cranial nerve.
Findings:
- The case describes a rare instance of retroclival pneumocephalus following pediatric TBI.
- This specific lesion resulted in bilateral abducens palsy.
- The study emphasizes the susceptibility of the sixth cranial nerve to compression from such lesions.
Implications:
- Increased diagnostic accuracy for posterior fossa lesions in children due to advanced imaging.
- Highlights the potential for unusual presentations of TBI, such as retroclival pneumocephalus.
- Underscores the importance of recognizing and managing posterior fossa lesions to prevent severe neurological deficits.
Abstract:
Traumatic brain injury (TBI) is less common in children than in adults. Posterior fossa lesions are even more uncommon, but, when present, are usually epidural hematomas. These lesions, even when small, may have a bad outcome because of the possibility of compression of the important structures that the infratentorial compartment contains, such as the brainstem and cranial nerves, and the constriction of the fourth ventricle, causing acute hydrocephalus. Although unusual, posterior fossa lesions are increasingly being diagnosed because of the better quality of and easier access to cranial tomography. In this paper, we report a case of a 12-year-old male patient who had suffered a TBI and presented with several pneumocephali, one of them in the retroclival region, causing a mass effect and then compression of the sixth cranial nerve which is the most susceptible to these injuries. We discuss these traumatic posterior fossa lesions, with an emphasis on retroclival pneumocephalus, not yet described in the literature in association with bilateral abducens palsy. In addition, we discuss associated lesions and the trauma mechanism.
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