Yesilaras Murat, Atilla Ozge Duman, Aksay Ersin, Kilic Turgay Yılmaz
Izmir Tepecik Research and Educational Hospital, Department of Emergency Medicine, Izmir, Turkey.
Izmir Tepecik Research and Educational Hospital, Department of Emergency Medicine, Izmir, Turkey.
Am J Emerg Med. 2014 Dec;32(12):1562.e1-2. doi: 10.1016/j.ajem.2014.05.043. Epub 2014 Jun 2.
Pneumocephalus is a clinical condition caused by dysbarism, trauma, and iatrogenic causes. The most common iatrogenic causes of pneumocephalus are major interventions as a neurosurgery and cardiovascular operations, endoscopy, and minor interventions as a peripheral and central venous access. Especially during insertion of central venous line and intravenous drug and fluid infusion, the venous air embolism may occur in emergency department. In these patients, retrograde pneumocephalus occurs as a result of the air entering the right atrium to the brain. Clinical effects of the air delivery rates are known to be more specific than the total amount of air. In general, intravenous administration of 300 to 500 mL air in the speed of 100 mL/min is considered to be lethal. Large amounts of air embolism can cause hypotension and acute circulatory collapse with intracardiac obstruction. The most common symptoms of venous air embolism are anxiety, dyspnea, chest pain, cyanosis, tachycardia, tachypnea, headache, confusion, agitation, syncope, slurred speech, blurred vision, seizures, and ataxia. The mortality of pneumocephalus caused by central venous catheters in patients presented with symptoms of focal neurologic was 8%, whereas the mortality of pneumocephalus in patients presented with encephalopathy was 36%. In our report, a case of pneumocephalus secondary to disconnection of catheter cap in chronic renal failure patient who has hemodialysis via catheter has been presented.
气颅是一种由气压伤、创伤和医源性原因引起的临床病症。气颅最常见的医源性原因是神经外科手术和心血管手术等大型干预、内窥镜检查，以及外周和中心静脉置管等小型干预。特别是在插入中心静脉导管以及静脉注射药物和输液期间，急诊科可能会发生静脉空气栓塞。在这些患者中，空气从右心房进入大脑会导致逆行性气颅。已知空气输送速率的临床影响比空气总量更具特异性。一般来说，以100 mL/分钟的速度静脉注射300至500 mL空气被认为是致命的。大量空气栓塞可导致低血压和急性循环衰竭，并伴有心内梗阻。静脉空气栓塞最常见的症状包括焦虑、呼吸困难、胸痛、发绀、心动过速、呼吸急促、头痛、意识模糊、躁动、晕厥、言语不清、视力模糊、癫痫发作和共济失调。出现局灶性神经症状的患者因中心静脉导管导致气颅的死亡率为8%，而出现脑病的患者气颅死亡率为36%。在我们的报告中，介绍了一例通过导管进行血液透析的慢性肾衰竭患者因导管帽断开连接继发气颅的病例。
