scholarly journals Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Ai Hosaka ◽  
Tetsuto Yamaguchi ◽  
Fumiko Yamamoto ◽  
Yasuro Shibagaki
Keyword(s):  
Head Trauma ◽  
Superior Sagittal Sinus ◽  
Skull Fracture ◽  
Air Embolism ◽  
Skull Fractures ◽  
Venous Air Embolism ◽  
Sagittal Sinus ◽  
The Right ◽  
Head Computed Tomography

Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures.

scholarly journals Parietal Foramen as A Landmark to Locate Intracranial Vascular and Parenchymal Structures

2020 ◽  
Author(s):  
Pedro Brainer-Lima ◽  
Alessandra Brainer-Lima ◽  
Maria Rosana Ferreira ◽  
Paulo Brainer-Lima ◽  
Marcelo Valença
Keyword(s):  
Parietal Lobe ◽  
Superior Sagittal Sinus ◽  
Average Distance ◽  
Air Embolism ◽  
Neurosurgical Procedures ◽  
Parietal Region ◽  
Sagittal Suture ◽  
Emissary Vein ◽  
Sagittal Sinus ◽  
The Right

Abstract The aim of this study was to define the location of the parietal foramina (PF) with reference to skull landmarks and correlate the PF with cerebral and vascular structures to optimize neurosurgical procedures in the intracranial compartment. Two hundred and thirty-eight parietal bones studied by magnetic resonance imaging (MRI) of 119 patients were reviewed. The cephalometric points, inion, bregma, sagittal suture and lambda were used as anatomical references to locate the PF and define its anatomical relationships to parenchymal cerebral structures, especially some eloquent areas. The PF was identified in the MRI in 83 of the 119 individuals (69.7%) and was located at an average distance of 9.5 ± 0.8 cm (mean ± SD) posteriorly and 0.9 ± 0.3cm laterally to the Bregma. In over 90% of cases, the PF was located within a 2 cm radius of the bregma-PF distance’s mean value. Surgeons operating in the parietal region should be aware of the frequency of PF (69.7%), its location (superolateral to lambda) and its stable relationship with underlying anatomical structures. 88% of the 62 left PF’s were situated within 1cm, laterally to the left margin of the superior sagittal sinus (SSS). 60% of the right PF were situated within 1.3 cm laterally from the right margin of the SSS, while 40% were directly above the SSS. We propose that the PF should be used as the reference for the superior sagittal sinus during its course through the parietal lobe, as its constancy overtakes other commonly used landmarks (sagittal suture and midline). In conclusion, clinicians should be aware of the PF to both avoid iatrogenic injury to an emissary vein that courses through it that can lead to air embolism and as a guide to maneuvering through the parietal region.

Venous-air embolism during vitrectomy for endoresection of choroidal melanoma: Case report

2021 ◽  
pp. 112067212199510
Author(s):  
Miroslava Paolah Meraz Gutiérrez ◽  
Efrain Jose Camara Rodriguez ◽  
Alejandra Pando Cifuentes ◽  
Grecia Yael Ortiz-Ramirez ◽  
Vidal Soberón Ventura
Keyword(s):  
Vision Loss ◽  
Choroidal Melanoma ◽  
Air Embolism ◽  
Orotracheal Intubation ◽  
Venous Air Embolism ◽  
Vascular Arcade ◽  
Pars Plana ◽  
The Right ◽  
Melanoma Case

Introduction: The purpose of this study is to report a case of venous-air embolism during a vitrectomy for endoresection of choroidal melanoma. Case description: A 31-year-old man went to the clinic because of photopsias and vision loss in his right eye. On fundoscopy of the right eye, a choroidal mass with an associated retinal detachment was found near the inferotemporal vascular arcade. Multimodal imaging was performed and diagnosis of choroidal melanoma was made. Metastatic workup ruled out systemic extension. The patient underwent pars plana vitrectomy for endoresection of the lesion. During the application of laser under air, he started complaining of chest pain and dyspnea. He presented signs of supraventricular tachycardia, tachypnea, hypotension and oxygen desaturation. He was managed with orotracheal intubation, bronchodilators and vasopressor support, and stabilization was achieved. He was discharged 2 days after with no sequalae. After 1-year of follow-up, the patient has a visual acuity of counting fingers and no signs of tumor recurrence or systemic extension. Conclusions: Although rare, vitreoretinal surgeons should be aware of this potentially fatal complication and take steps to prevent it.

scholarly journals Feline head trauma: a CT analysis of skull fractures and their management in 75 cats

2018 ◽  
Vol 21 (12) ◽  
pp. 1120-1126 ◽  
Author(s):  
Rebekah Knight ◽  
Richard L Meeson
Keyword(s):  
Risk Factors ◽  
Head Trauma ◽  
Bone Fractures ◽  
Skull Fracture ◽  
Dental Occlusion ◽  
Skull Fractures ◽  
Common Cause ◽  
Increased Risk ◽  
Multiple Regions ◽  
Upper Jaw

Objectives The aim of this study was to describe and evaluate the configurations and management of feline skull fractures and concurrent injuries following head trauma. Methods Medical records and CT images were reviewed for cats with skull fractures confirmed by CT that were managed conservatively or with surgery. Details of signalment, presentation, skull fracture configuration, management, re-examination, and complications or mortality were recorded and analysed. Results Seventy-five cats (53 males, 22 females) with a mean age of 4.8 ± 3 years met the inclusion criteria. Eighty-nine percent of cats had fractures in multiple bones of the skull, with the mandible, upper jaw (maxilla, incisive and nasal bones) and craniofacial regions most commonly affected. Temporomandibular joint injury occurred in 56% of cats. Road traffic accidents (RTAs) were the most common cause of skull fractures, occurring in 89% of cats, and caused fractures of multiple regions of the skull. RTAs were also associated with high levels of concurrent injuries, particularly ophthalmic, neurological and thoracic injuries. A more limited distribution of injuries was seen in non-RTA cats. Equal numbers of cats were managed conservatively or surgically (47%). Mortality rate was 8% and complications were reported in 22% of cats. Increasing age at presentation and presence of internal upper jaw fractures were risk factors for development of complications. No risk factors were identified for mortality. Conclusions and relevance RTAs were the most common cause of feline skull fractures and resulted in fractures in multiple regions of the skull and concurrent injuries occurred frequently. Problems with dental occlusion were uncommon post-treatment. An increased risk of implant loosening and malocclusion was seen with palatine and pterygoid bone fractures and hard palate injuries. This study provides useful additional information regarding feline skull fractures, concurrent injuries and management techniques following head trauma.

Lateral Ventricle to Sylvian Fissure Shunt for Obstructive Hydrocephalus: First Report

2017 ◽  
Vol 78 (05) ◽  
pp. 513-516
Author(s):  
Sushil Patkar
Keyword(s):  
Lateral Ventricle ◽  
Fourth Ventricle ◽  
Superior Sagittal Sinus ◽  
Obstructive Hydrocephalus ◽  
Shunt Operation ◽  
Ventriculoatrial Shunt ◽  
Sagittal Sinus ◽  
Suprasellar Cistern ◽  
Sylvian Cistern

AbstractCerebrospinal fluid (CSF) pathway studies have revealed that the CSF secreted from the choroid plexus of the ventricles after egressing from the fourth ventricle reaches the basal suprasellar cistern and ultimately the sylvian cisterns. From the sylvian cistern, the CSF travels over the cerebral convexity subarachnoid space to reach the superior sagittal sinus and enters the bloodstream. Diverting CSF from the lateral ventricle with a shunt catheter to the sylvian cistern can be an option to treat obstructive hydrocephalus. An adult patient with posttraumatic hydrocephalus with contraindications to ventriculoperitoneal and ventriculoatrial shunt placement underwent this procedure of diverting CSF from the lateral ventricle to the sylvian cistern successfully, and he had immediate relief of symptoms of raised intracranial pressure. Although preliminary results seem logical and promising, more cases and longer follow-up is required to consider this shunt operation an option in the treatment of obstructive hydrocephalus.

scholarly journals Diagnostic and Clinical Management of Skull Fractures in Children

2016 ◽  
Vol 6 ◽  
pp. 47
Author(s):  
Christoph Arneitz ◽  
Maria Sinzig ◽  
Günter Fasching
Keyword(s):  
Hospital Stay ◽  
Head Trauma ◽  
Clinical Management ◽  
Skull Fracture ◽  
Neurological Symptoms ◽  
Ct Scans ◽  
Skull Fractures ◽  
X Rays ◽  
Minor Head Trauma ◽  
The Mean

Objective: The indications of routine skull X-rays after mild head trauma are still in discussion, and the clinical management of a child with a skull fracture remains controversial. The aim of our retrospective study was to evaluate our diagnostic and clinical management of children with skull fractures following minor head trauma. Methods: We worked up the medical history of all consecutive patients with a skull fracture treated in our hospital from January 2009 to October 2014 and investigated all skull X-rays in our hospital during this period. Results: In 5217 skull radiographies, 66 skull fractures (1.3%) were detected. The mean age of all our patients was 5.9 years (median age: 4.0 years); the mean age of patients with a diagnosed skull fracture was 2.3 years (median age: 0.8 years). A total of 1658 children (32%) were <2 years old. A typical boggy swelling was present in 61% of all skull fractures. The majority of injuries were caused by falls (77%). Nine patients (14%) required a computed tomography (CT) scan during their hospital stay due to neurological symptoms, and four patients had a brain magnetic resonance imaging. Nine patients (14%) showed an intracranial hemorrhage (ICH; mean age: 7.3 years); one patient had a neurosurgery because of a depressed skull fracture. Nine patients (14%) were observed at our pediatric intensive care unit for a mean time of 2.9 days. The mean hospital stay was 4.2 days. Conclusions: Our findings support previous evidence against the routine use of skull X-rays for evaluation of children with minor head injury. The rate of diagnosed skull fractures in radiographs following minor head trauma is low, and additional CT scans are not indicated in asymptomatic patient with a linear skull fracture. All detected ICHs could be treated conservatively. Children under the age of 2 years have the highest risk of skull fractures after minor head trauma, but do not have a higher incidence of intracranial bleeding. Neuroobservation without initial CT scans is safe in infants and children following minor head trauma and CT scans should be reserved for patients with neurological symptoms.

Delayed Neurological Deterioration after Depressed Fracture over Superior Sagittal Sinus: Our Experience with 13 Patients

2020 ◽  
Vol 81 (04) ◽  
pp. 324-329
Author(s):  
Ahmed Elshanawany ◽  
Mahmoud Ragab
Keyword(s):  
Computed Tomography ◽  
Superior Sagittal Sinus ◽  
Skull Fracture ◽  
Csf Pressure ◽  
Visual Deterioration ◽  
Depressed Skull Fracture ◽  
Sagittal Sinus ◽  
Depressed Fracture ◽  
Neurologic Deterioration ◽  
Management Protocol

Abstract Objective To present our experience in the diagnosis and management protocol of 13 patients with a depressed skull fracture over the superior sagittal sinus (SSS) who developed delayed neurologic deterioration. Patients and Methods This retrospective study was conducted in the Neurosurgical Department, Assiut University Hospitals, between May 2012 and May 2017. All patients with a depressed skull fracture over the SSS were reviewed. Only those patients who were neurologically intact after trauma but suffered delayed neurologic deterioration were included in this study. Preoperative characteristics of age, sex, cause of trauma, type and site of the depressed skull fracture, and clinical presentation were reviewed and evaluated. Neuroimaging including brain computed tomography and computed tomography venography were evaluated. Results Of 612 patients with depressed skull fractures admitted to our department, 63 had the fracture segment on the SSS. Thirteen patients, nine males and four females, met the inclusion criteria (age range: 5–42 years). The most common cause of trauma was assault from others (seven patients). Eight patients had a compound depressed fracture; the other five fractures were simple. Interval between trauma and neurologic deterioration ranged between 4 days and 3 weeks. Clinical deterioration included decrease of consciousness, headache, blurred vision, and repeated vomiting. Deterioration of consciousness was seen in four patients. Eight patients had sixth cranial nerve palsy. Visual deterioration was seen in four patients. All the included patients were operated on for elevation of the depressed segment. Eleven patients improved; two patients who presented initially with visual deterioration did not improve. Their visual deterioration persisted after surgery. For both these patients, lumbar puncture revealed high cerebrospinal fluid (CSF) pressure. Clinical improvement followed the insertion of a thecoperitoneal shunt. Conclusion Increased intracranial pressure (ICP) may follow a depressed fracture over the SSS. It may occur immediately after trauma or later. Surgical decompression with elevation of the depressed segment is indicated. Persistence of manifestations of raised ICP despite elevation of the depressed segment indicates the occurrence of an SSS thrombosis. CSF pressure should be measured to confirm the diagnosis and consider a thecoperitoneal shunt.

scholarly journals Hyperthyroidism as a Precipitant Factor for Cerebral Venous Thrombosis: A Case Report

2020 ◽  
Vol 8 ◽  
pp. 232470962094930
Author(s):  
Ahmed Elkhalifa Elawad Elhassan ◽  
Mohammed Omer Khalil Ali ◽  
Amina Bougaila ◽  
Mohammed Abdelhady ◽  
Hassan Abuzaid
Keyword(s):  
Case Report ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Laboratory Findings ◽  
Sagittal Sinus ◽  
History Of ◽  
Sagittal Sinus Thrombosis ◽  
Superior Sagittal Sinus Thrombosis

Cerebral venous sinus thrombosis (CVT) is an uncommon yet serious condition. While CVT has many known precipitants and etiologies, hyperthyroidism as a precipitant of CVT is not well understood. This study reported a case of a 41-year-old male with a 4-year history of hyperthyroidism presented with seizure. Consequently, a diagnosis of superior sagittal sinus thrombosis was confirmed by computed tomography and magnetic resonance (MR) venograms. Extensive investigations yielded no apparent underlying cause, but laboratory findings were consistent with uncontrolled hyperthyroidism. The patient improved rapidly following anticoagulation. Follow-up MR and MRV scans 2 months after treatment revealed full recanalization of the superior sagittal sinus. This case report highlighted hyperthyroidism, as a procoagulant condition, resulting specifically in superior sagittal sinus thrombosis.

The pseudodelta sign in acute head trauma

1988 ◽  
Vol 69 (6) ◽  
pp. 867-868 ◽  
Author(s):  
Joel W. Yeakley ◽  
John S. Mayer ◽  
Larry L. Patchell ◽  
K. Francis Lee ◽  
Michael E. Miner
Keyword(s):  
Head Trauma ◽  
Superior Sagittal Sinus ◽  
Ct Scans ◽  
Content Type ◽  
Sagittal Sinus ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Triangular Area ◽  
Fine Print

✓ The “delta sign” is a triangular area of high density with a low-density center seen on contrast-enhanced computerized tomography (CT) scans in the location of the superior sagittal sinus. It indicates thrombosis of the sinus. The authors describe the “pseudodelta sign,” which is similar but is seen on non-contrast-enhanced CT scans and which has a high correlation with hemorrhage secondary to acute head trauma.

A pilot study and novel angiographic classification for superior sagittal sinus stenting in patients with non-thrombotic intracranial venous occlusive disease

2017 ◽  
Vol 10 (1) ◽  
pp. 74-77 ◽  
Author(s):  
Daniel M S Raper ◽  
Thomas J Buell ◽  
Dale Ding ◽  
I Jonathan Pomeraniec ◽  
R Webster Crowley ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Superior Sagittal Sinus ◽  
Venous Pressure ◽  
Transverse Sinus ◽  
Occlusive Disease ◽  
Pressure Gradients ◽  
Frontal Pole ◽  
Sagittal Sinus

ObjectiveSafety and efficacy of superior sagittal sinus (SSS) stenting for non-thrombotic intracranial venous occlusive disease (VOD) is unknown. The aim of this retrospective cohort study is to evaluate outcomes after SSS stenting.MethodsWe evaluated an institutional database to identify patients who underwent SSS stenting. Radiographic and clinical outcomes were analyzed and a novel angiographic classification of the SSS was proposed.ResultsWe identified 19 patients; 42% developed SSS stenosis after transverse sinus stenting. Pre-stent maximum mean venous pressure (MVP) in the SSS of 16.2 mm Hg decreased to 13.1 mm Hg after stenting (p=0.037). Preoperative trans-stenosis pressure gradient of 4.2 mm Hg decreased to 1.5 mm Hg after stenting (p<0.001). No intraprocedural complication or junctional SSS stenosis distal to the stent construct was noted. Improvement in headache, tinnitus, and visual obscurations was reported by 66.7%, 63.6%, and 50% of affected patients, respectively, at mean follow-up of 5.2 months. We divided the SSS into four anatomically equal segments, numbered S1–S4, from the torcula to frontal pole. SSS stenosis typically occurs in the S1 segment, and the anterior extent of SSS stents was deployed at the S1–S2 junction in all but one case.ConclusionsSSS stenting is reasonably safe, may improve clinical symptoms, and significantly reduces maximum MVP and trans-stenosis pressure gradients in patients with VOD with SSS stenosis. The S1 segment is most commonly stenotic, and minimum pressure gradients for symptomatic SSS stenosis may be lower than for transverse or sigmoid stenosis. Additional studies and follow-up are necessary to better elucidate appropriate clinical indications and long-term efficacy of SSS stenting.

Venous air embolism in swine: transport of gas bubbles through the pulmonary circulation

1990 ◽  
Vol 69 (1) ◽  
pp. 237-244 ◽  
Author(s):  
A. Vik ◽  
A. O. Brubakk ◽  
T. R. Hennessy ◽  
B. M. Jenssen ◽  
M. Ekker ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Gas Bubbles ◽  
Air Embolism ◽  
Threshold Value ◽  
Maximum Increase ◽  
Venous Air Embolism ◽  
Mean Pulmonary Arterial Pressure ◽  
Significant Difference ◽  
Group 2 ◽  
The Right

The assumption that the lung is an effective filter for gas bubbles is of importance for certain occupations (e.g., divers, astronauts) as well as in the accomplishment of several medical procedures. The filtering capacity was tested in pigs by use of continuous air infusion into the right ventricle and a transesophageal echocardiographic transducer for detection of air in the left atrium. Twenty pigs, anesthetized with pentobarbital sodium and mechanically ventilated, were divided into groups that received air at infusion rates of 0.05 (group 1a, n = 7), 0.10 (group 2, n = 6), and 0.20 (group 3, n = 5) ml.kg-1.min-1. Two pigs served as controls. The breakthrough incidence was 0, 67, and 100%, respectively. Group 1a received a second infusion of 0.10 ml.kg-1.min-1 (group 1b, n = 7), and spillover of bubbles occurred in only 14% of these pigs. Infusion of gas caused a maximum increase in mean pulmonary arterial pressure (PAP) of 129 +/- 9% to 39.2 +/- 1.3 (SE) mmHg, with no significant difference between the groups. Breakthrough was observed only in animals with a dramatic reduction in mean arterial pressure and a PAP that returned to almost-normal values at spillover time. Our results suggest that the threshold value for breakthrough of air bubbles in pigs is reduced compared with that in dogs. The hemodynamic consequences at a given infusion rate are, however, greatly enhanced.

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