Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy
Dacryocystorhinostomy is a surgical procedure used for restoring the flow of tears from the lacrimal sac into the nose. The surgery creates a new tear drain between your eyes and nose. You may require the surgery if your tear duct has become blocked. Although this procedure is the standard treatment for nasolacrimal duct obstruction, complications are often possible. In this case an 85-year-old man underwent endoscopic DCR and after 1 month developed a complication. Doctors diagnosed him with delayed unilateral pneumocephalus.
The 85-year-old Asian man presented with epiphora and binocular stinging sensation. His history revealed that he had a cerebrovascular accident and hypertension. In addition to this, he also underwent a bilateral cataract surgery in 2015 and an eye glaucoma surgery in 2010. Irrigation of the lacrimal canaliculi showed that both lacrimal ducts were obstructed. The patient also underwent bilateral endoscopic DCRs with silicone tube intubation. There were no signs of anatomic variation during the procedure. Doctors discharged him in good health on the 4th day of admission.
4 days after the procedure the patient revisited the emergency room.
4 days later the patient returned to the emergency room with complaints of generalised weakness and poor oral intake. However, there were no signs of mental change or headaches. Doctors advised blood tests and urinalysis for further investigations which showed no significant findings. His vital signs were also normal. The patient was discharged after supportive treatment and hydration without any ophthalmologic complications.
A month later the patine returned to the emergency room and was admitted with lethargy and drowsiness for 2 days. All examinations including fiberoptic examination was normal. There was no sign of fever, although, his C-reactive protein was elevated. Further investigations showed no signs of cerebrospinal fluid rhinorrhoea or bony dehiscence. Chest CT was evident of aspiration pneumonia.
Doctors concluded that the symptoms were a because of delayed unilateral pneumocephalus after bilateral endoscopic DCR.
References
Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient https://casereports.bmj.com/content/14/5/e241540
