Neumoencéfalo espontáneo. A propósito de un caso.

Abstract

Introduction and objective: Pneumocephalus is the presence of air in any of the intracranial compartments (intraventricular, intraparenchymal, subarachnoid, subdural and epidural), generally associated with a loss of bone continuity after surgical procedures or trauma, and rarely occurs without a triggering factor (2%). Through the presentation of a clinical case, we will explain the fundamental characteristics of this entity and review the literature. Method: A 48-year-old man attended the Emergency Department after a recent onset of severe headache in the right hemicranium of five days' evolution, initially controlled with paracetamol, which progressively worsened without response to analgesia; at this time, he presented blurred vision and cervicalgia. A cranial CT scan was requested, and, in view of the findings, the patient was referred to the Otorhinolaryngology and Neurosurgery Department Results: Pneumocephalus located in the left frontal region and cerebral sickle, as well as small bubbles in the left occipital region and in the right cavernous sinus. Dehiscence at the level of the lamina cribrosa of the ethmoid in the left nostril. In view of these findings, in-hospital observation and intravenous analgesic treatment was carried out for two weeks with satisfactory evolution and a new CT scan was performed where no pneumocephalus was observed in the cerebral parenchyma, with the previously described dehiscence persisting Discussion: The appearance of spontaneous pneumocephalus is usually secondary to a defect in cranial bone continuity, being a very rare entity (2%); the presence of pneumocephalus usually occurs after surgery, craniofacial trauma, or skull base tumors. As a complication we can find tension pneumocephalus, which is due to the entry of intracranial gas that raises the pressure, producing a valve effect with the entry of air, but not its exit, requiring surgical treatment. This entity manifests clinically with headache, nausea, vomiting and even convulsions and alterations in the neurological state. Cranial CT is still the technique of choice for diagnosis. When it is a chance finding, conservative management is chosen, and it resolves spontaneously in about two weeks. If it presents symptoms, skull base fractures, or an air defect >15 mm, surgical treatment is considered. Conclusions: In the presence of headache with other neurological symptoms associated with poor response to analgesic treatment, pneumocephalus should be included in the differential diagnosis, especially in the presence of previous cranial surgery or trauma. Resolution is usually spontaneous, but we must consider the possibility of the appearance of tension pneumocephalus, so close intrahospital surveillance is necessary