Tension Pneumocephalus: An Uncommon Cause of Altered Mental Status

Abstract Background Pneumocephalus is a rare cause of altered mental status in patients presenting to the Emergency Department. Occurring as a result of traumatic or iatrogenic violation of the dura, it can cause significant morbidity and mortality if tension physiology develops whereby air continue...

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Bibliographic Details
Published inThe Journal of emergency medicine Vol. 44; no. 2; pp. 340 - 343
Main Authors Simmons, Joshua, MD, Luks, Andrew M., MD
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.02.2013
Subjects
Aged, 80 and over
altered mental status
Confusion - etiology
Emergency
endoscopic sinus surgery
Endoscopy - adverse effects
Headache - etiology
Humans
Male
Neurologic Examination
Paranasal Sinus Diseases - surgery
Pneumocephalus - complications
Pneumocephalus - diagnosis
Pneumocephalus - etiology
tension pneumocephalus
Tomography, X-Ray Computed
Vomiting - etiology
altered mental status
tension pneumocephalus
endoscopic sinus surgery
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Summary:Abstract Background Pneumocephalus is a rare cause of altered mental status in patients presenting to the Emergency Department. Occurring as a result of traumatic or iatrogenic violation of the dura, it can cause significant morbidity and mortality if tension physiology develops whereby air continues to accumulate with no mechanism for escape. Objective This case report will review the underlying pathophysiology, clinical presentation, diagnosis, and management of tension pneumocephalus. Case Report We present the case of an 89-year-old man who presented to the Emergency Department with declining mental status 9 h after endoscopic sinus surgery. He was subsequently found to have tension pneumocephalus and underwent emergent burr hole evacuation. Despite resolution of the pneumocephalus, the patient had persistent neurologic deficits related to ischemic infarcts that occurred as a result of the tension physiology and subsequently expired in the hospital. Conclusion This case illustrates the importance of considering tension pneumocephalus on the differential diagnosis for any patient presenting with altered mental status after surgical or diagnostic procedures with potential to violate the dural space.
Bibliography:ObjectType-Case Study-2
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ObjectType-Report-1
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ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2012.01.055