Spontaneous intraparenchymal tension pneumocephalus triggered by compulsive forceful nose blowing (original) (raw)
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How Dangerous Can Be Nasal Excessive Blowing
Global Journal of Otolaryngology, 2017
The patient presented here it's a very rare case of pneumosinus dilatans frontalis discovered accidentally and suddenly because of a spontaneous palpebral and orbital emphysema after a simple act of blowing his nose. Pneumosinus dilatans is a rare pathology usually involving the frontal sinus, but is possible a ethmoidal, sphenoidal or a maxillary involvement. Definition of this entity-a progressive enlargement usually bilateral but sometimes unilateral with normal lining mucosa, no signs of infection and the sinus content just air. The cause of these disease is not known, there are a few theories like an obstruction of the naso-frontal duct with increased intrasinus pressure. The symptoms are poor /or absent-most of the cases frontal bossing is the first sign or it is a radiological discovery. But not all the large frontal sinuses are pneumosins dilatans-we have to prove progressive expansion, comparing on an annual X-ray the sizes of the sinus.
Turkish Journal of Pediatric Emergency and Intensive Care Medicine
Air can be detected in various anatomical regions during the course of several diseases. This accumulation of air is often seen as pneumothorax and subcutaneous emphysema. Rarely extraordinary regions such as skull base and spinal region can be involved. In the majority of the patients, it is caused by trauma, iatrogenic factors and Valsalva maneuver. Supportive treatment is generally sufficient. A 14-year-old boy with psychosis who developed extensive air in the scull base, the neck, the orbita, mediastinum, abdomen, retroperitoneum, spinal canal, scrotum and head of the femur was presented. In the course of psychiatric disorders, in the case of excessive shouting and self-harm as a result of squeezing the throat, beside subcutaneous emphysema, air existing in the various anatomical regions of the body should be kept in mind.
Empty nose syndrome: etiopathogenesis and management
The Egyptian Journal of Otolaryngology, 2016
Empty nose syndrome (ENS) is an iatrogenic disorder most often recognized by the presence of paradoxical nasal obstruction despite an objectively wide patent nasal cavity. It occurs after inferior and/or middle turbinate resection; however, individuals with normal turbinates and intranasal volume may also complain of ENS. Its pathophysiology remains unclear, but it is probably caused by wide nasal cavities affecting the neurosensitive receptors and inhaled air humidification. Neuropsychological involvement is also suspected. Not every patient undergoing radical turbinate resection experiences the symptoms of ENS. ENS can affect the normal breathing function of the nasal cavity, with subsequent deterioration in patients' quality of life. The diagnosis is made on the basis of the patients' history, endoscopic examination of the nasal cavity, imaging (computed tomography imaging and functional MRI), and rhinomanometry. Prevention is the most important strategy; thus, the inferior and middle turbinate should not be resected without adequate justification. Management is problematic including nasal cavity hygiene and humidification, with surgery reserved for the most severe cases. The surgery aims at partial filling of the nasal cavity using different techniques and implant materials. In this paper, we review both the etiology and the clinical presentation of ENS, and its conservative and surgical management. Core tip Empty nose syndrome (ENS) is encountered after inferior and/or middle turbinate resection; however, it can occur in patients with seemingly normal turbinates. Rhinologists should avoid routine resection of the inferior and middle turbinates. It is not certain why some patients develop ENS, whereas others do not. The frequent association with psychiatric disorders and possibly psychosomatic pathologies indicate the possible role of psychological stress in some patients. Its diagnosis relies on clinical suspicion and physical examination. Nasal augmentation surgery can improve the quality of life of patients by restoring nasal anatomy toward the premorbid state.
Romanian Journal of Rhinology
Empty nose syndrome (ENS) is a clinical entity lacking consensual meaning, illustrating a rare nose surgery complication, particularly of nasal conchae surgery, which results in the destruction of the normal nasal tissue. In severe forms it may become debilitating; the inability in identification and appreciation of this syndrome turns detrimental to the patient. Physiopathology remains controversial, which probably implies disorders caused by excessive nasal permeability, affecting neurosensory receptors as well as the humidification functions and conditioning of inhaled air. Neuropsychological involvement is being suspected. Symptomatology is both variable and changeable, the most evident sign outlining paradoxical nasal obstruction. The diagnosis is based on a series of symptoms that need to be collected precisely, the objective examination that highlights the permeability of nasal fossae. The management is problematic; there are implemented a complete range of simple hygiene and...
Post-Traumatic Pneumocele of the Frontal Sinus
Korean Journal of Radiology, 2008
Post-Traumatic Pneumocele of the Frontal Sinus A pneumocele is an abnormal dilatation of a paranasal sinus, most commonly affecting the frontal sinus. Although the etiology of pneumocele is not entirely known, several causative factors have been suggested including trauma, surgery, tumor and infection. We report here a case of post-traumatic pneumocele of the frontal sinus following a head trauma. pneumocele of the frontal sinus is a rare disorder that can accompany a facial deformity. A pneumocele is characterized by the pathological expansion of the aerated sinus lined by normal mucosa. Pneumoceles most commonly affect the frontal sinus, followed in frequency by the sphenoid, ethmoid and maxillary sinuses (1). The etiology of a pneumocele is still unclear, but it might occur after head trauma, nasal polyposis, sinus surgery, chronic sinusitis and the formation of a tumor. We report a case of pneumocele of the frontal sinus and suggest that the pneumocele occurred after trauma to the head in a patient. CASE REPORT A 46-year-old man was admitted to our hospital with a 4-week history of headache and a growing mass on the left forehead. The patient had a history of severe head trauma due to a traffic accident that occurred 21 years prior. Over the intervening years, the patient had noticed a slowly growing mass on the left forehead. A physical examination demonstrated the presence of a hard mass, about 6 6 cm in size, on the left forehead. There were no abnormal findings after both a neurological and ophthalmological examination. Cranial multi-detector computed tomography (MDCT) was performed using a 64-MDCT unit (Aquilion 64; Toshiba, Tokyo, Japan) with a 0.5mm-section width, a rotation time of 500 ms, tube voltage of 120 kV and tube current of 180 mA. The reconstructed images were processed, and multiplanar reformatted and three-dimensional (3D) volume-rendering (VR) images were processed on a separate workstation (Vitrea 2; Vital Images, Plymouth, MN). These images showed an abnormally expanded left frontal sinus with concurrent thinning of the bony wall (Figs. 1A C). There was no sign of frontal bone fracture, despite the previous cranial trauma. Coronal reformatted MDCT images showed that the left frontal recess was obliterated with a soft tissue density. The other sinuses were normal. The 3D CT VR image showed an abnormal protrusion of the forehead due to a pneumocele of the frontal sinus (Fig. 1D). Surgical treatment was offered as an option for correcting the deformity but was refused by the patient.
An unusual cause of altered mental status
The Journal of Emergency Medicine, 1995
A case of altered mental status secondary to plMUlU as a complication of sinus surgery is presented. The patho@wsiology, cWcp1 presentation, diagnosis, and management of pneumocephatus are discussed.
Traumatic tension pneumocephalus: A series of 4 cases managed in Zaria
2016
Tension pneumocephalus is the accumulation of air in the intracranial cavity with attendant neurological changes. Though a neurosurgical emergency, it could present in a delayed form requiring a high index of suspicion. We report a series of four cases; two of which were managed operatively and two non-operatively with good outcome. Keywords : Aerocele, imaging, otorrhoea, outcome, rhinorrhoea, trauma
Tension pneumocephalus: an extremely small defect leading to an extremely serious problem
American Journal of Otolaryngology, 2013
Background: Pneumocephalus is a pathology characterized by air influx into the intracranial region. It may occur after head trauma and rarely after endoscopic sinus surgery. As the amount of air increases, this can cause neurological disorders with a mass effect and this condition is called tension pneumocephalus. Case description: Our case is a 65-year-old woman. Tension pneumocephalus developed 12 h after endoscopic sinus surgery performed for nasal polypectomy. Since tension pneumocephalus developed very rapidly in the patient creating a herniation table, the patient was taken to theater immediately. A burr-hole was drilled into the skull and a small defect in the ethmoid roof was closed with a layered closure technique. Post-operative conservative treatment was applied (bed rest, raising the bed head, meningitis prophylaxis, loop diuretics, abstaining from maneuvers increasing the Valsalva). Discussion: In the literature, it is stated that, in the case of a small defect, spontaneous resolution may be provided with conservative treatment, but as the size of the defect increases, neurological effects will occur more quickly and be more obvious. In our case, a herniation table developed leading to neurological and vital problems in a more rapid and more obvious way than in other tension pneumocephalus cases developing after endoscopic sinus surgery. We consider that this situation is related to a very small defect size. Conclusion: Tension pneumocephalus is a complication rarely seen after endoscopic sinus surgery, but if it is not treated immediately, it may give rise to serious morbidity and mortality concerns. The clinical course developing after tension pneumocephalus may be very serious when very small defects are involved.
The functional and psychological burden of empty nose syndrome
International forum of allergy & rhinology, 2018
Empty nose syndrome (ENS) is a debilitating disorder thought to arise as a postsurgical phenomenon from excessive loss of nasal tissues. Affected patients often report a profound impact on all aspects of life, but the extent of this burden has not been quantified. We sought to determine the association of ENS with mental health and functional impairments. A cross-sectional study was performed of individuals with ENS recruited from online ENS forums. ENS status was validated based on a positive 6-item Empty Nose Syndrome Questionnaire (ENS6Q) score and sinus computed tomography imaging or supporting medical documentation. Subjects completed the ENS6Q, the 9-item Patient Health Questionnaire (PHQ-9) for depression, the 7-item Generalized Anxiety Disorder questionnaire (GAD-7), the Epworth Sleepiness Scale for daytime somnolence (ESS), the Work Productivity and Impairment questionnaire (WPAI), and the 5-dimension EuroQol General Health State Survey (EQ-5D-5L). Pearson correlation analy...