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The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases

Summary

A review of 284 eases of pneumocephalus collected from the literature with 11 additional cases reported by the author, making a total of 295 reported cases, is presented. Of the 295 cases, trauma was the etiological factor in 218 cases (73.9%). Neoplasm was the pathological basis in 38 cases (12.9%). In 26 cases (8.8%) pneumocephalus was secondary to infection. In 11 cases (3.7%) it was secondary to some type of surgical intervention. There were 2 cases in which no apparent etiology was found (0.6%). The occurrence of pneumocephalus depends upon two basic factors which must be present in all cases: (1) a difference between extracranial and intracranial pressure, the former being greater, and (2) a defect in the bony coverings of the brain. In those cases of subdural, subarachnoid, or intracerebral pneumocephalus there must also be a defect in the dura. Headache was the most common symptom and occurred in 113 cases. Cerebrospinal fluid rhinorrhea occurred in 91 cases. The only symptom and physical finding that was pathognomonic of pneumocephalus was the “bruit hydro-aérique,” and this occurred in 21 of the cases. Meningitis occurred in 68 cases. The most frequent time of onset of symptoms of pneumocephalus was from 1 to 3 months from beginning of symptoms (28.4%).

Zusammenfassung

Es wird eine Übersicht über 295 Fälle mit Pneumozephalus gegeben. Davon stammen 284 Fälle aus dem Schrifttum und 11 Fälle aus dem eigenen Krankengut des Autors. Von den 295 Fällen waren 218 (73,9%) traumatischer Genese. 38 Fälle (12,9%) wurden durch ein Neoplasma verursacht. In 26 Fällen (8,8%) entstand der Pneumozephalus sekundär als Folge einer Infektion. In 11 Fällen (3,7%) war er die sekundäre Folge verschiedener Arten chirurgischer Eingriffe. Schließlich gibt es 2 Fälle, deren Genese nicht geklärt werden konnte (0,6%).

Das Auftreten eines Pneumozephalus hängt von zwei grundsätzlichen Faktoren ab, die immer gegeben sein müssen:

  1. 1.

    einer Differenz zwischen dem extrakraniellen und intrakraniellen Druck zugunsten des extrakraniellen und

  2. 2.

    ein Defekt in den knöchernen Schädelbedeckungen.

In Fällen mit subduralem, subarachnoidalem oder intrazerebralem Pneumozephalus muß außerdem ein Defekt in der Dura vorhanden sein.

Kopfschmerz war das häufigste Symptom und kam bei 113 Fällen vor. Eine Liquorfistel aus der Nase fand sich bei 91 Fällen. Der einzige klinischpathognomonische Befund war ein Plätschergeräusch, das bei 21 Fällen festgestellt worden war. Eine Meningitis trat bei 68 Fällen auf. Die Zeit zwischen dem Beginn der Symptome und dem Einsetzen einer deutlichen Symptomatologie eines Pneumozephalus lag im Mittel zwischen einem und drei Monaten.

Resumé

L'auteur présente une étude de 284 cas de pneumatocèles trouvés dans la littérature, et de onze observations personnelles, soit au total un rapport de 295 cas. Du point de vue étiologique:

Le traumatisme occupe la première place avec 208 cas, soit 73,9%.

Viennent ensuite les néoformations avec 38 cas, soit 12,9%.

26 cas sont d'origine infectieuse, soit 28,8%.

11 cas (3,7%) sont secondaires à certaines interventions.

Enfin dans 2 cas l'étiologie était indéterminée (0,6%).

L'apparition de pneumatocèle dépend de deux facteurs déterminants qui doivent être retrouvés dans tous les cas: 1°) — unedifférence entre la pression intracranienne et la pression extracranienne, cette dernière étant supérieure à la première. 2°) — une fracture du crâne.

Dans les pneumatocèles sous-duraux et ventriculaires il y a obligatoirement une déchirure de la dure-mère.

Le symptôme le plus fréquemment observé est représenté par les céphalées qui s'observent dans 113 cas. — La rhinorrhée s'observe dans 91 cas. — Le seul signe pathognomonique est le «bruit hydro-aérique» qui s'observe dans 21 cas. — La méningite se voit dans 68 cas.

Les symptômes apparaissent 1 à 3 mois après le début de la maladie.

Riassunto

Si espongono le considerazioni su 284 casi di pneumocefalo tratti dalla letteratura medica e di 11 casi trattati dall'A.

Di detti 295 casi, il trauma era il fattore etiologico in 218 di essi (73,9%); in 38 casi ca base patologioa era costituita da in neoplasma (12,9%). In 26 casi (8,8%) il pneumocefalo era susseguente ad un'infezione, in 11 casi (3,7%) susseguiva ad alcuni tipi di intervento chirurgico. Solo in 2 casi (0,6%) non fu possibile accertarne l'etiologia.

L'insorgere di un pneumocefalo dipende da due fattori fondamentali che devono essere presenti in ogni caso:

  1. 1)

    una differenza tra la pressione extracranica e quella endocranica, la prima maggiore della seconda;

  2. 2)

    un difetto nella teca ossea ricoprente il cervello. Nei casi di pneumocefalo subdurale, subaracnoideo o endocerebrale vi deve essere anche un difetto della dura madre.

In 113 casi il sintomo più comune era la cefalea. In 91 casi v'era rinorrea cerebro-spinale. L'unico segno fisico o l'unico sintomo patognomonico del pneumocefalo era il «rumore idro-serico» ed esso fu rilevato in 31 casi. In 68 casi si ebbe meningite. L'acme della sintomatologia si manifesto a distanza da uno a tre mesi dall'inizio dei sintomi (28,4%). Dei 295 casi passati in rivista nella relazione solo due non denunziarono un'etiologia apparente.

Uno di essi é riportato ampiamente. Degli 11 casi trattati dall'A. 9 erano di origine post-traupmatica, 1 postoperatorio ed 1 di origine non individuata.

Resumen

El autor presenta un estudio de 284 casos de pneumatoceles hallados en la literatura y de 11 observaciones personales, o sea un total de 295 casos. Desde el punto de vista etiológico concluye que:

  • Los traumatismos ocupan el primer lugar con 268 casos (73,9%)

  • Las neformaciones comprenden 38 casos (12,9%)

  • 26 easos son de origen infeccioso (28,8%)

  • 11 casos (3,7%) son secundarios a ciertas intervenciones

  • y por último en 2 casos no se determinó la etiología (0.6%).

La aparición de un pneumatocele depende de dos factores determinantes, que deben encontrarse en todos los casos: 1°) una diferencia entre la presión intracraneal y la extracraneal, ésta última sería superior a la primera y 2°) una fractura de craneo.

En los pneumatoceles subdurales y ventriculares siempre hay un desgarro de la duramadre.

El síntoma observado más frecuentemente fueron las cefaleas (113 casos) Rinorrea se observó en 91 casos. El único signos patognomónico es el „ruido hidro-aéreo“, que pudo observarse en 21 casos. Se vieron meningitis en 68 casos).

Los síntomas aparecían de 1 a 3 meses después del comienzo del proceso.

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Markham, J.W. The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta neurochir 16, 1–78 (1967). https://doi.org/10.1007/BF01401900

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Keywords

  • Meningitis
  • Dura
  • Intracranial Pressure
  • Additional Case
  • Physical Finding