Limits...
Incidence, radiographical features, and proposed mechanism for pneumocephalus from intravenous injection of air.

Tran P, Reed EJ, Hahn F, Lambrecht JE, McClay JC, Omojola MF - West J Emerg Med (2010)

Bottom Line: These cases are characterized clinically by the absence of signs and symptoms of pathologic pneumocephalus and radiographically by the distribution of air densities along the cranial venous system on head CTs.Idiopathic and presumed IV-induced pneumocephalus could be considered in the workup of ED patients with unexplained intracranial air on head CT if there are no findings of pathological causes for the pneumocephalus on history and physical examination and if the head CTs show a characteristic distribution of air limited to the cranial venous system.Knowledge of this clinical entity in the evaluation of ED patients with unexplained pneumocephalus can lead to more efficient emergency care and less patient anxiety.

View Article: PubMed Central - PubMed

Affiliation: University of Nebraska Medical Center, Department of Emergency Medicine, Omaha, NE.

ABSTRACT

Background: Pneumocephalus typically implies a traumatic breach in the meningeal layer or an intracranial gas-producing infection. Unexplained pneumocephalus on a head computed tomography (CT) in an emergency setting often compels emergency physicians to undertake aggressive evaluation and consultation.

Methods: In this paper, we report three cases of pneumocephalus that appear to result from retrograde injection of air through an intravenous (IV) catheter. We also performed a retrospective study to determine the incidence of presumed IV-induced pneumocephalus and etiologies of pneumocephalus in our emergency department (ED) population.

Results: The incidence of idiopathic and presumed IV-induced pneumocephalus was 0.034% among all head CTs ordered in the ED and 4.88% among cases of pneumocephalus seen in the ED. These cases are characterized clinically by the absence of signs and symptoms of pathologic pneumocephalus and radiographically by the distribution of air densities along the cranial venous system on head CTs.

Conclusion: Idiopathic and presumed IV-induced pneumocephalus could be considered in the workup of ED patients with unexplained intracranial air on head CT if there are no findings of pathological causes for the pneumocephalus on history and physical examination and if the head CTs show a characteristic distribution of air limited to the cranial venous system. Knowledge of this clinical entity in the evaluation of ED patients with unexplained pneumocephalus can lead to more efficient emergency care and less patient anxiety.

No MeSH data available.


Related in: MedlinePlus

(Case 2). Axial cranial computed tomography through multiple levels in an 87-year-old female who presented to the emergency department with the chief complaint of altered mental status. Air is seen in the in the right cavernous sinus (white arrow heads, B), right superior orbital veins (black arrow head, A) and right superficial temporal veins (arrow, B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC2908654&req=5

f2-wjem-11-180: (Case 2). Axial cranial computed tomography through multiple levels in an 87-year-old female who presented to the emergency department with the chief complaint of altered mental status. Air is seen in the in the right cavernous sinus (white arrow heads, B), right superior orbital veins (black arrow head, A) and right superficial temporal veins (arrow, B).

Mentions: An 87-year old-female presented to the ED with the chief complaint of altered mental status. The family stated that the patient was agitated more than usual, with no history of a recent fall, head trauma, fever, or surgery. A peripheral IV line was placed during the initial management. The initial head CT without contrast in the ED showed gas in the right cavernous sinus and superior ophthalmic vein (Figure 2). The patient was admitted for observation and medical management. The consensus by the admitting service and neuroradiology was that the pneumocephalus was iatrogenic, presumably from IV injection of air. The patient was discharged to an assisted living facility two days later. A follow-up CT scan two months later showed complete resolution of the pneumocephalus.


Incidence, radiographical features, and proposed mechanism for pneumocephalus from intravenous injection of air.

Tran P, Reed EJ, Hahn F, Lambrecht JE, McClay JC, Omojola MF - West J Emerg Med (2010)

(Case 2). Axial cranial computed tomography through multiple levels in an 87-year-old female who presented to the emergency department with the chief complaint of altered mental status. Air is seen in the in the right cavernous sinus (white arrow heads, B), right superior orbital veins (black arrow head, A) and right superficial temporal veins (arrow, B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2908654&req=5

f2-wjem-11-180: (Case 2). Axial cranial computed tomography through multiple levels in an 87-year-old female who presented to the emergency department with the chief complaint of altered mental status. Air is seen in the in the right cavernous sinus (white arrow heads, B), right superior orbital veins (black arrow head, A) and right superficial temporal veins (arrow, B).
Mentions: An 87-year old-female presented to the ED with the chief complaint of altered mental status. The family stated that the patient was agitated more than usual, with no history of a recent fall, head trauma, fever, or surgery. A peripheral IV line was placed during the initial management. The initial head CT without contrast in the ED showed gas in the right cavernous sinus and superior ophthalmic vein (Figure 2). The patient was admitted for observation and medical management. The consensus by the admitting service and neuroradiology was that the pneumocephalus was iatrogenic, presumably from IV injection of air. The patient was discharged to an assisted living facility two days later. A follow-up CT scan two months later showed complete resolution of the pneumocephalus.

Bottom Line: These cases are characterized clinically by the absence of signs and symptoms of pathologic pneumocephalus and radiographically by the distribution of air densities along the cranial venous system on head CTs.Idiopathic and presumed IV-induced pneumocephalus could be considered in the workup of ED patients with unexplained intracranial air on head CT if there are no findings of pathological causes for the pneumocephalus on history and physical examination and if the head CTs show a characteristic distribution of air limited to the cranial venous system.Knowledge of this clinical entity in the evaluation of ED patients with unexplained pneumocephalus can lead to more efficient emergency care and less patient anxiety.

View Article: PubMed Central - PubMed

Affiliation: University of Nebraska Medical Center, Department of Emergency Medicine, Omaha, NE.

ABSTRACT

Background: Pneumocephalus typically implies a traumatic breach in the meningeal layer or an intracranial gas-producing infection. Unexplained pneumocephalus on a head computed tomography (CT) in an emergency setting often compels emergency physicians to undertake aggressive evaluation and consultation.

Methods: In this paper, we report three cases of pneumocephalus that appear to result from retrograde injection of air through an intravenous (IV) catheter. We also performed a retrospective study to determine the incidence of presumed IV-induced pneumocephalus and etiologies of pneumocephalus in our emergency department (ED) population.

Results: The incidence of idiopathic and presumed IV-induced pneumocephalus was 0.034% among all head CTs ordered in the ED and 4.88% among cases of pneumocephalus seen in the ED. These cases are characterized clinically by the absence of signs and symptoms of pathologic pneumocephalus and radiographically by the distribution of air densities along the cranial venous system on head CTs.

Conclusion: Idiopathic and presumed IV-induced pneumocephalus could be considered in the workup of ED patients with unexplained intracranial air on head CT if there are no findings of pathological causes for the pneumocephalus on history and physical examination and if the head CTs show a characteristic distribution of air limited to the cranial venous system. Knowledge of this clinical entity in the evaluation of ED patients with unexplained pneumocephalus can lead to more efficient emergency care and less patient anxiety.

No MeSH data available.


Related in: MedlinePlus