An unusual case of infective pneumocephalus: case report of pneumocephalus exacerbated by continuous positive airway pressure

BMC Emergency Medicine - Tập 18 - Trang 1-6 - 2018
Abdus Samad Ansari1, Brittany B. Dennis2, Dilip Shah1, Winfred Baah3
1Acute Medical Unit, Epsom and St. Helier University Hospital NHS Trust, London, England, UK
2St. George’s University of London, London, England (UK)
3Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana

Tóm tắt

Pneumocephalus, illustrated by air in the cranial vault is relatively infrequent and generally associated with neurosurgery, trauma, meningitis and barotrauma. However cases of spontaneous non-traumatic pneumocephalus remain rare. While the relationship between continuous positive airway pressure (CPAP) and atraumatic pneumocephalus has been previously reported, to our knowledge the rare presentation associated with sinus wall osteomyelitis has never been described. We summarize here the case of a 67-year-old woman’s acute presentation of Streptococcus salvarius infection after a sudden drop in her consciousness. The patient was brought to hospital by family reporting a one week history of sudden deterioration, cognitive decline, and lethargy. The patient presented with reduced arousal, cognitive function (Glasgow Coma Scale: 10, Abbreviated Mental Test Score:CS, 0 AMTS), and no history of trauma. Computed Tomography (CT) imaging was ordered and identified a significant pneumocephalus with no cranial defect. Further investigations acknowledged possible sinus or middle ear disease, which was highlighted by the discovery of S. salivarius by polymerase chain reaction (PCR) and potentially exacerbated by the use of nocturnal continuous positive airway pressure (CPAP). The patient made a complete recovery by eliminating likely causative factors and long term regimental antibiotics administration. This case highlights a rare neurological presentation of S. salivarius infection with a mixed aetiology of spontaneous pneumocephalus. This case features an atypical complication associated with CPAP use, and to our knowledge is the first case to be associated with sinus wall osteomyelitis. Recognition of the clinical features and risk factors for spontaneous pneumocephalus –while rare—serve to broaden our clinical index of suspicion when presented with patients experiencing neurological deficit. Information from this case may also aid in improving prevention, early diagnosis, and future management.

Tài liệu tham khảo

Lee JS, Park YS, Kwon JT, Suk JS. Spontaneous pneumocephalus associated with pneumosinus dilatans. J Korean Neurosurg Soc. 2010;47:395–8. Nair SR, Henry MT. Pneumocephalus induced by non-invasive ventilation: a case report. Respir Med Extra. 2005;1:75–7. Tagg JR, Dierksen KP. Bacterial replacement therapy: adapting “germ warfare” to infection prevention. Trends Biotechnol. 2003:217–23. Wilson M, Martin R, Walk ST, Young C, Grossman S, McKean EL, et al. Clinical and laboratory features of Streptococcus salivarius meningitis: a case report and literature review. Clin. Med. Res. [Internet]. 2012;10:15–25. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3280456&tool=pmcentrez&rendertype=abstract. Legert KG, Zimmerman M, Stierna P. Sinusitis of odontogenic origin: pathophysiological implications of early treatment. Acta Otolaryngol. 2004:655–63. https://www.ncbi.nlm.nih.gov/pubmed/15515486. Klopfenstein CE, Pneumocephalus FA. A Complication of continuous positive airway pressure after trauma. Chest. 1980;78:656–7. http://journal.chestnet.org/article/S0012-3692(16)40237-0/fulltext. Du T. Pneumatocele du crane. Arch Gen Med. 1866;1:34–55. Pishbin E, Azarfardian N, Salarian M, Ganjeifar B. Spontaneous Nontraumatic Pneumocephalus: A Case Report. Iran. Red Crescent Med. J. [Internet]. 2015;17:4–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4583710/pdf/ircmj-17-07-23920.pdf. Strumpf DA, Harrop P, Dobbin J, Millman RP. Massive epistaxis from nasal CPAP therapy. Chest. 1989;95:1141. http://journal.chestnet.org/article/S0012-3692(16)30418-4/fulltext. Brander PE, Soirinsuo M, Lohela P. Nasopharyngeal symptoms in patients with obstructive sleep apnea syndrome. Effect of nasal CPAP treatment. Respiration. [internet], Available from. 1999;66:128–35. http://www.ncbi.nlm.nih.gov/pubmed/10202316.