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Symptomatic Postoperative Compressive Pneumocephalus After Cholecystectomy.

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Altered mental status in patients with chronic hydrocephalus may indicate serious complications. Prompt diagnosis and intervention are crucial, as exemplified by this case of delayed recognition in an emergency setting.

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Area of Science:

  • Neurosurgery
  • Neurology

Background:

  • A 75-year-old female with a history of chronic hydrocephalus due to aqueductal stenosis presented with altered mental status.
  • Previous surgical history includes a ventriculoperitoneal shunt (1970) complicated by meningitis, followed by a ventriculocisternostomy (2004).
  • Recently underwent laparoscopic cholecystectomy complicated by an intra-abdominal collection.

Purpose of the Study:

  • To highlight the importance of considering complications in patients with chronic hydrocephalus presenting with altered mental status.
  • To illustrate a case of delayed diagnosis in an emergency department setting.

Main Methods:

  • Clinical examination revealing a Glasgow Coma Scale score of 8 (E3V1M4).
  • Emergency department presentation with tonic-clonic seizures.
  • Cerebral CT scan demonstrating massive compressive pneumocephalus.
  • Neurosurgical intervention.

Main Results:

  • The patient experienced two tonic-clonic seizures.
  • Cerebral CT scan confirmed massive compressive pneumocephalus.
  • The patient was admitted to the neurosurgery department for surgical management.

Conclusions:

  • Altered mental status in patients with a history of chronic hydrocephalus warrants prompt investigation for potential complications.
  • This case underscores the challenges and potential delays in diagnosing critically ill patients within an emergency department setting.