Tension pneumocephalus mimicking septic shock: a case report

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Neurology

Background:

• Tension pneumocephalus is a potentially life-threatening complication following neurosurgical procedures.
• It can cause rapid neurological decline and is often associated with cerebrospinal fluid leaks.
• Early recognition and management are crucial for patient survival and recovery.

Observation:

• A 64-year-old patient developed altered mental status and gait instability post-olfactory groove meningioma resection.
• Imaging revealed significant tension pneumocephalus, leading to worsening neurological status, respiratory failure, and shock.
• The patient presented with signs mimicking septic shock, but without evidence of infection.

Findings:

• Tension pneumocephalus was identified as the cause of aseptic systemic inflammatory response syndrome (SIRS) in this patient.
• Neurosurgical intervention, including needle decompression and repair of a cranial fossa defect, was performed.
• Critical care support, including vasopressors, was essential for managing the shock and multiorgan dysfunction.

Implications:

• This case highlights the first reported association between tension pneumocephalus and aseptic SIRS mimicking septic shock.
• Prompt neurosurgical correction of pneumocephalus, alongside critical care, effectively reversed neurological deterioration and shock.
• Close monitoring for progressive pneumocephalus in postoperative patients is vital to prevent severe complications.