Tension pneumoventricle: Reversible cause for aphasia

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Pneumocephalus, or air in the cranium, is often seen after surgery or head injury.
• Tension pneumocephalus occurs when intracranial pressure increases due to this air, leading to neurological decline.
• Tension pneumoventricle, a rare form, involves intraventricular air compressing brain centers, potentially causing expressive aphasia.

Observation:

• A young male with severe head injury and extradural hematoma developed a cerebrospinal fluid (CSF) leak.
• The patient presented with aphasia and loss of bowel/bladder control, with CT scans revealing tension pneumoventricles.
• Conservative management failed, leading to neurological deterioration including unequal pupils and a decreased Glasgow Coma Scale (GCS).

Findings:

• Immediate surgical intervention involving aspiration of ventricular air and insertion of an external ventricular drain was performed.
• Postoperatively, the patient's neurological status rapidly improved, with normal speech returning by day four.
• This case highlights the link between tension pneumoventricles and expressive aphasia.

Implications:

• Tension pneumoventricles should be recognized as a potential cause of aphasia.
• Prompt reduction of intracranial pressure is critical for reversing neurological deficits and improving patient outcomes.
• Early diagnosis and intervention in cases of traumatic CSF leak with pneumoventricles can prevent severe neurological sequelae.