J Korean Neurosurg Soc.  2009 May;45(5):318-321. 10.3340/jkns.2009.45.5.318.

Extensive Tension Pneumocephalus Caused by Spinal Tapping in a Patient with Basal Skull Fracture and Pneumothorax

• Lee SH
• Koh JS
• Bang JS
• Kim MC

• KMID: 1495127
• DOI: http://doi.org/10.3340/jkns.2009.45.5.318

Abstract

Tension pneumocephalus may follow a cerebrospinal fluid (CSF) leak communicating with extensive extradural air. However, it rarely occurs after diagnostic lumbar puncture, and its treatment and pathophysiology are uncertain. Tension pneumocephalus can develop even after diagnostic lumbar puncture in a special condition. This extremely rare condition and underlying pathophysiology will be presented and discussed. The authors report the case of a 44-year-old man with a basal skull fracture accompanied by pneumothorax necessitating chest tube suction drainage, who underwent an uneventful lumbar tapping that was complicated by postprocedural tension pneumocephalus resulting in an altered mental status. The patient was managed by burr hole trephination and saline infusion following chest tube disengagement. He recovered well with no neurologic deficits after the operation, and a follow-up computed tomography (CT) scan demonstrated that the pneumocephalus had completely resolved. Tension pneumocephalus is a rare but serious complication of lumbar puncture in patients with basal skull fractures accompanied by pneumothorax, which requires continuous chest tube drainage. Thus, when there is a need for lumbar tapping in these patients, it should be performed after the negative pressure is disengaged.

Keyword

Pneumocephalus; Pneumothorax; Spinal tapping

MeSH Terms

Adult
Chest Tubes
Drainage
Follow-Up Studies
Humans
Neurologic Manifestations
Pneumocephalus
Pneumothorax
Skull
Skull Fractures
Spinal Puncture
Suction