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[Two cases of traumatic intracerebral pneumocephalus]
Insights
Traumatic intracerebral pneumocephalus, a rare head trauma complication, involves air in the brain due to herniated brain tissue. Surgical repair of craniodural defects resolved pneumocephalus and cerebrospinal fluid (CSF) rhinorrhea in two cases.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Radiology
Background:
- Intracerebral pneumocephalus is a rare but serious complication following head trauma.
- It is characterized by the presence of air within the brain parenchyma.
- This condition can arise from a defect in the dura mater and skull base, allowing air entry.
Observation:
- Two cases of traumatic intracerebral pneumocephalus are presented in adolescent and adult male patients.
- Both patients sustained head concussions from motorbike accidents.
- Delayed diagnosis was noted, with air detected 15-17 days post-injury via CT and MRI, showing brain herniation into sinuses.
Findings:
- Surgical intervention via bilateral frontal craniotomy successfully repaired craniodural defects in the ethmoid and frontal sinuses.
- Patients presented with cerebrospinal fluid (CSF) rhinorrhea prior to surgery.
- Post-operative follow-up confirmed resolution of pneumocephalus and CSF rhinorrhea without recurrence.
Implications:
- Herniation of contused brain into a craniodural defect is a likely mechanism for post-traumatic intracerebral pneumocephalus.
- Prompt surgical repair of dural defects is crucial for managing this condition.
- Effective treatment prevents recurrence and resolves associated symptoms like CSF rhinorrhea.
Abstract:
Two cases of traumatic intracerebral pneumocephalus, a rare complication of head trauma, are presented. Case 1: A 14-year-old boy had a strong concussion in his forehead due to a motorbike accident. Slightly obtunded on admission showing GCS 10, he became conscious in several days. Head CT performed after 17 days showed a round air image in the right frontal lobe which kept increasing in size thereafter. Bilateral frontal craniotomy was performed 31 days after the injury. A craniodural defect with a herniated brain was found in the superior wall of the posterior ethmoid sinus and repaired. Case 2: A 55-year-old man received a left forehead concussion when his motorbike ran into a car from behind. Although he had been conscious ever since admission, head CT after 15 days showed a round air image in the left frontal lobe. MRI demonstrated the air to be located in the cerebral parenchyma distinctly and the brain to have herniated into the frontal sinus. As the air showed a tendency to increase in volume and mild psychic and memory disturbances appeared, bilateral frontal craniotomy was performed 34 days after the injury. A craniodural defect with a herniated brain was detected in the posterior wall of the frontal sinus and repaired. These two patients showed a small amount of cerebrospinal fluid (CSF) rhinorrhea before the operation. Following the surgical repair, no recurrence of pneumocephalus and CSF rhinorrhea has been seen in either case. Intracerebral pneumocephalus secondary to closed head trauma was thought to have been due to herniation of contused brain into a craniodural defect.(ABSTRACT TRUNCATED AT 250 WORDS)