Polster Sean P, Obuobi Shirlene, Brutto Victor J Del, Avner Kenneth, Markopoulou Aikaterini, Wong Ricky H
Department of Surgery, Section of Neurosurgery, University of Chicago, Chicago, USA.
Department of Neurosurgery, Northshore University Health System, Evanston, Illinois, USA.
Surg Neurol Int. 2018 Sep 21;9:193. doi: 10.4103/sni.sni_190_18. eCollection 2018.
Pneumocephalus is a common finding following intracranial procedures, typically asymptomatic and resolves within several days. However, in some cases, pneumocephalus presents with headache, encephalopathy, or symptoms of elevated intracranial pressure. Here, we present a case of iatrogenic tension pneumocephalus following endoscopic sinus surgery, presenting as abnormal involuntary movements resembling a movement disorder with choreiform movements.
A 67-year-old previously healthy male presented with new onset chorea and dystonia associated with headache, encephalopathy, and postural instability 4 days after undergoing endoscopic sinus surgery for chronic sinusitis and nasal polyps. Computed tomography showed prominent intraventricular pneumocephalus causing enlargement of the anterior horns of both lateral ventricles with lateral displacement of the basal ganglia nuclei and a bony defect in the skull base. Neurosurgical correction of the cranial defect provided complete symptomatic resolution. Pneumocephalus as a result of an iatrogenic injury of the skull base manifesting as an acute movement disorder is a rare complication of a nasal sinus procedure. We speculate that compression of the caudate nucleus and striatum resulted in decreased pallidothalamic inhibition and thalamocortical disinhibition leading to the development of a hyperkinetic movement disorder.
This unusual presentation of a common procedure illustrates a neurological emergency that requires prompt recognition and timely correction.
气颅是颅内手术后常见的表现，通常无症状，数天内可自行缓解。然而，在某些情况下，气颅会出现头痛、脑病或颅内压升高的症状。在此，我们报告一例内镜鼻窦手术后发生的医源性张力性气颅病例，表现为类似舞蹈样动作的异常不自主运动，类似于运动障碍。
一名67岁既往健康的男性，在因慢性鼻窦炎和鼻息肉接受内镜鼻窦手术后4天，出现新发的舞蹈症和肌张力障碍，伴有头痛、脑病和姿势不稳。计算机断层扫描显示显著的脑室内气颅，导致双侧侧脑室前角扩大，基底节核团向外侧移位，以及颅底骨质缺损。神经外科对颅骨缺损进行修复后，症状完全缓解。因颅底医源性损伤导致的气颅表现为急性运动障碍，是鼻窦手术罕见的并发症。我们推测尾状核和纹状体受压导致苍白球丘脑抑制减弱和丘脑皮质去抑制，从而引发运动亢进性运动障碍。
这一常见手术的不寻常表现说明了一种需要及时识别和纠正的神经急症。
