Alharbi Ahoud, Khairy Sami, Alkhani Ahmed
Department of Surgery, Division of Neurosurgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Surg Neurol Int. 2022 Jun 17;13:249. doi: 10.25259/SNI_994_2021. eCollection 2022.
Pneumocephalus is the presence of air in the intracranial cavity secondary to communication with the extracranial compartment. It occurs spontaneously, after trauma, or after a cranial surgery.
A 62-year-old female, a known case of diabetes mellitus, presented to our emergency department with a sudden thunderclap headache. She was diagnosed with subarachnoid hemorrhage secondary to ruptured anterior communicating artery aneurysm. Twenty days later, she developed pneumonia and subsequently had a cardiac arrest. She was revived after 26 min of cardiopulmonary resuscitation. She developed pneumothorax requiring a chest tube insertion. After the first trial, she developed a diffuse subcutaneous emphysema, and the chest tube was reinserted. Afterward, she became unresponsive with dilated pupils. A computed tomography (CT) scan of the brain showed a diffuse subcutaneous emphysema reaching up to the face with air around the ventriculoperitoneal shunt distal catheter and extending through the burr hole to the ventricles causing pneumocephalus. There was no evidence of skull base fractures on brain CT. Unfortunately, the patient did not recover and passed away 3 days later.
This report describes the presentation and radiological findings of an interesting case of pneumocephalus following iatrogenic diffuse subcutaneous emphysema. It aims to increase the emphasis on early anticipation of such rare complication after subcutaneous emphysema.
气颅是指由于与颅外腔隙相通而导致颅内腔隙内出现气体。它可自发出现、发生于外伤后或开颅手术后。
一名62岁女性，已知患有糖尿病，因突发霹雳样头痛就诊于我院急诊科。她被诊断为前交通动脉动脉瘤破裂继发蛛网膜下腔出血。20天后，她发生了肺炎，随后心脏骤停。经过26分钟的心肺复苏后她恢复了自主循环。她出现了气胸，需要插入胸腔闭式引流管。首次置管后，她出现了弥漫性皮下气肿，于是重新插入胸腔闭式引流管。之后，她出现瞳孔散大且对刺激无反应。脑部计算机断层扫描（CT）显示弥漫性皮下气肿蔓延至面部，脑室腹腔分流术远端导管周围有气体，并通过钻孔延伸至脑室，导致气颅。脑部CT未发现颅底骨折的迹象。不幸的是，患者未能康复，3天后死亡。
本报告描述了一例医源性弥漫性皮下气肿后气颅的临床表现及影像学表现。目的是提高对皮下气肿后这种罕见并发症早期预判的重视。
