Simmons Joshua, Luks Andrew M
Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington, USA.
J Emerg Med. 2013 Feb;44(2):340-3. doi: 10.1016/j.jemermed.2012.01.055. Epub 2012 Apr 14.
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.
This case report will review the underlying pathophysiology, clinical presentation, diagnosis, and management of tension pneumocephalus.
We present the case of an 89-year-old man who presented to the Emergency Department with declining mental status 9h 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.
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.
气颅是急诊科患者精神状态改变的罕见原因。它是由于硬脑膜受到创伤或医源性侵犯所致，如果出现张力性生理状态，即空气持续积聚且无排出机制，可导致严重的发病率和死亡率。
本病例报告将回顾张力性气颅的潜在病理生理学、临床表现、诊断和治疗。
我们报告一例89岁男性患者，在内镜鼻窦手术后9小时因精神状态下降就诊于急诊科。随后发现他患有张力性气颅，并接受了紧急钻孔引流术。尽管气颅得到缓解，但患者因张力性生理状态导致缺血性梗死而出现持续的神经功能缺损，最终在医院死亡。
本病例说明了对于任何在可能侵犯硬脑膜间隙的手术或诊断操作后出现精神状态改变的患者，在鉴别诊断中考虑张力性气颅的重要性。
