A 61-year-old man began having seizure like activity while undergoing re-staging computed tomography, with a history of stage IIIB squamous cell carcinoma of the lung.
The patient had previously received three cycles of carboplatin and nonoparticle albumin-bound paclitaxel (Abraxane) and had a known cavitary lesion. He developed sudden respiratory failure and confusion, therefore was shifted to the emergency department where he was intubated immediately.
CT scan of the head showed diffuse pneumocephalus, whereas, the re-staging CT of the chest showed that the cavitary lesion that had been identified recently formed a fistula between a bronchus in the right lower lobe and left atrium. The aetiology of the pneumocephalus was thought to be an air embolism that originated from the bronchial fistula.
Pneumocephalus, also known as intracranial aerocele or pneumatocele is defined as the presence of air in the subarachnoid, subdural and epidural space within the ventricular cavities or parenchyma of the brain. Pneumocephalus can either be congenital, traumatic, infectious, neoplastic, iatrogenic or spontaneous. In this case, the cause of pneumocephalus originated from a bronchial fistula, a rare vascular malformation. It is further classified as simple pneumocephalus or tension pneumocephalus. If it lasts less than 72 hours, it is classified as acute, whereas, if it persists for 72 hours or more, it is classified as chronic pneumocephalus.
Pneumocephalus presents with the following symptoms:
- CSF leak from the surgical site, ear or nose
- Persistent headache after spinal or cranial surgery
- Seizures after surgery
- Postoperative meningitis
- Frontal lobe syndrome
The patient later passed away in the intensive care unit.
Zakko, A., & Bakhtiar, H. (2020). Pneumocephalus Due to a Bronchoatrial Fistula. New England Journal of Medicine, 382(20), 1942-1942.