Pneumocephalus in neonatal meningitis

Pneumocephalus: case illustrations and review

BACKGROUND

Pneumocephalus is commonly encountered after neurosurgical procedures but can also be caused by craniofacial trauma and tumors of the skull base and rarely, can occur spontaneously. Contributing factors for the development of pneumocephalus include head position, duration of surgery, nitrous oxide (N(2)O) anesthesia, hydrocephalus, intraoperative osmotherapy, hyperventilation, spinal anesthesia, barotauma, continuous CSF drainage via lumbar drain, epidural anesthesia, infections, and neoplasms. Clinical presentation includes headaches, nausea and vomiting, seizures, dizziness, and depressed neurological status. In this article, we review the incidence, mechanisms, precipitating factors, diagnosis, and management of pneumocephalus. Search of Medline, databases, and manual review of article bibliographies. Considering four case illustrations that typify pneumocephalus in clinical practice, we discuss the common etiologies, and confirm the diagnosis with neuroimaging and management strategies. Avoidance of contributing factors, high index of suspicion, and confirmation with neuroimaging are important in attenuating mortality and morbidity. A significant amount of pneumocephalus can simulate a space-occupying lesion. Supplemental oxygen increases the rate of absorption of pneumocephalus.

An unusual appearance of discitis due to gas-forming Escherichia coli with associated pneumocephalus

STUDY DESIGN

Case report.

OBJECTIVE

To report on an unusual case of isolated septic discitis, meningitis, pneumocephalus, and solid organ abscesses associated with urosepsis from gas-producing Escherichia coli.

SUMMARY OF BACKGROUND DATA

Isolated septic discitis, or disc infection without involvement of adjacent vertebrae, following E. coli urosepsis is an unusual finding in the adult population and to our knowledge has not been reported previously.

METHODS

The clinical manifestations and imaging findings of a patient with a history of back pain are described. The significance of the reported case is discussed.

RESULTS

Laboratory finding and imaging studies revealed a Gram-negative sepsis associated with meningitis, discitis, pneumocephalus, and solid organ abscesses. Due to widespread involvement of multiple organs, the infection remained refractory to treatment, and the patient died.

CONCLUSION

Our report adds to the literature by describing an unusual appearance of spine infection in an adult. Furthermore, it emphasizes the importance of a systematic approach to the diagnosis and treatment of low back pain.