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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

“Mount Fuji” sign. Axial cranial computed tomography through the level of frontal horns shows a large subdural bilateral pneumocephalus post-operatively. Note the compression of the frontal lobes and widening of the interhemispheric space between the frontal lobes, simulating the appearance of Mount Fuji.
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f4-wjem-11-180: “Mount Fuji” sign. Axial cranial computed tomography through the level of frontal horns shows a large subdural bilateral pneumocephalus post-operatively. Note the compression of the frontal lobes and widening of the interhemispheric space between the frontal lobes, simulating the appearance of Mount Fuji.

Mentions: On a head CT without contrast, pneumocephalus is best seen on a soft tissue window. Air having a Hounsfield unit of approximately −1,000 can be distinguished from fat (−50), water (0–10), and gray/white matter (20–30). The presence of tension pneumocephalus may show the findings of “Mount Fuji” (Figure 4) or “Bubbling Brain.”8,9


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)

“Mount Fuji” sign. Axial cranial computed tomography through the level of frontal horns shows a large subdural bilateral pneumocephalus post-operatively. Note the compression of the frontal lobes and widening of the interhemispheric space between the frontal lobes, simulating the appearance of Mount Fuji.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4-wjem-11-180: “Mount Fuji” sign. Axial cranial computed tomography through the level of frontal horns shows a large subdural bilateral pneumocephalus post-operatively. Note the compression of the frontal lobes and widening of the interhemispheric space between the frontal lobes, simulating the appearance of Mount Fuji.
Mentions: On a head CT without contrast, pneumocephalus is best seen on a soft tissue window. Air having a Hounsfield unit of approximately −1,000 can be distinguished from fat (−50), water (0–10), and gray/white matter (20–30). The presence of tension pneumocephalus may show the findings of “Mount Fuji” (Figure 4) or “Bubbling Brain.”8,9

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