Case Study: Today’s word is Pneumocephalus
An 84-year-old man presented to the emergency department following recurrent falls over several weeks and onset of new left-sided weakness. CT of the brain revealed a large air cavity (pneumatocoele) in the right frontal lobe thought to be secondary to an ethmoidal osteoma communicating through the cribriform plate allowing air to be forced into the skull under pressure. Subsequent MRI confirmed these findings and also revealed a small focal area of acute infarction in the adjacent corpus callosum. The patient had a prolonged hospital stay, declined neurosurgical intervention and was discharged home on secondary stroke prevention.
Let’s unpack this, shall we? An elderly patient goes to the emergency room (A&E for you Brits) following recurrent falls. He gets an x-ray CT that shows a “bubble” in part of the brain. A diffusion weighted MRI (DWI) was also performed. Both CT and MRI show presence of an osteoma (abnormal bone growth/benign bone tumor), near the lower part of the “bubble”. DWI also showed sign of an infarct (blood clot/blood vessel occlusion) which would have been missed by CT. Remember, CT is good for bone visualization and MRI is good for soft tissue visualization. CT or magnetic resonance angiogram would have been helpful to differentiate between tension pneumocephalus causing arterial obstruction with secondary ischaemia and arterial thrombosis. An angiogram is an image of the blood vessels, typically using a injected contrast agent.
So the “bubble” in his brain is called a pneumocephalus. A pneumatocoele (air cavity) it typically found in the lungs. I can spend hours looking at case studies in Radiopaedia.
Full article:
BMJ Case Reports 2018; doi:10.1136/bcr-2017-222892
Unusual association of diseases/symptoms
CASE REPORT
The man that lost (part of) his mind
Pneumocephalus
https://radiopaedia.org/articles/pneumocephalus
More info:
Medical Imaging 101 pt 3: MRI
Medical Imaging 101 pt 2: CT
https://www.livescience.com/61975-missing-brain-air-pocket.html
If the patient hadn’t refused treatment, what would of been done to alleviate the problem? And would the brain pop back to normal size then?
The man will die.
Tom Nathe they said that they would remove the osteoma and I don’t remember the second part. I’ll look at it again shortly.
Is surgery the only treatment?
Steroids to reduce inflammation?
Siromi Samarasinghe they also gave him medicine to reduce the risk of stroke. It could resolve on its own. However, they kept him long enough (in my opinion) for that to start.
Pilar Allen he doesn’t really have a problem of inflammation.
Chad Haney Thanks Chad.
Tom Nathe the part I couldn’t remember was suture repair after clearing the pressure from the cavity.
Terrible thing to have to go throw it must take your breath you need to be under a specialist care all the time until your cured