Cargando…
An unusual presentation of dystonia and chorea from intraventricular pneumocephalus
BACKGROUND: Pneumocephalus is a common finding following intracranial procedures, typically asymptomatic and resolves within several days. However, in some cases, pneumocephalus presents with headache, encephalopathy, or symptoms of elevated intracranial pressure. Here, we present a case of iatrogen...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169345/ https://www.ncbi.nlm.nih.gov/pubmed/30294497 http://dx.doi.org/10.4103/sni.sni_190_18 |
_version_ | 1783360502787735552 |
---|---|
author | Polster, Sean P. Obuobi, Shirlene Brutto, Victor J. Del Avner, Kenneth Markopoulou, Aikaterini Wong, Ricky H. |
author_facet | Polster, Sean P. Obuobi, Shirlene Brutto, Victor J. Del Avner, Kenneth Markopoulou, Aikaterini Wong, Ricky H. |
author_sort | Polster, Sean P. |
collection | PubMed |
description | BACKGROUND: Pneumocephalus is a common finding following intracranial procedures, typically asymptomatic and resolves within several days. However, in some cases, pneumocephalus presents with headache, encephalopathy, or symptoms of elevated intracranial pressure. Here, we present a case of iatrogenic tension pneumocephalus following endoscopic sinus surgery, presenting as abnormal involuntary movements resembling a movement disorder with choreiform movements. CASE DESCRIPTION: A 67-year-old previously healthy male presented with new onset chorea and dystonia associated with headache, encephalopathy, and postural instability 4 days after undergoing endoscopic sinus surgery for chronic sinusitis and nasal polyps. Computed tomography showed prominent intraventricular pneumocephalus causing enlargement of the anterior horns of both lateral ventricles with lateral displacement of the basal ganglia nuclei and a bony defect in the skull base. Neurosurgical correction of the cranial defect provided complete symptomatic resolution. Pneumocephalus as a result of an iatrogenic injury of the skull base manifesting as an acute movement disorder is a rare complication of a nasal sinus procedure. We speculate that compression of the caudate nucleus and striatum resulted in decreased pallidothalamic inhibition and thalamocortical disinhibition leading to the development of a hyperkinetic movement disorder. CONCLUSION: This unusual presentation of a common procedure illustrates a neurological emergency that requires prompt recognition and timely correction. |
format | Online Article Text |
id | pubmed-6169345 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-61693452018-10-05 An unusual presentation of dystonia and chorea from intraventricular pneumocephalus Polster, Sean P. Obuobi, Shirlene Brutto, Victor J. Del Avner, Kenneth Markopoulou, Aikaterini Wong, Ricky H. Surg Neurol Int Unique Case Observations: Case Report BACKGROUND: Pneumocephalus is a common finding following intracranial procedures, typically asymptomatic and resolves within several days. However, in some cases, pneumocephalus presents with headache, encephalopathy, or symptoms of elevated intracranial pressure. Here, we present a case of iatrogenic tension pneumocephalus following endoscopic sinus surgery, presenting as abnormal involuntary movements resembling a movement disorder with choreiform movements. CASE DESCRIPTION: A 67-year-old previously healthy male presented with new onset chorea and dystonia associated with headache, encephalopathy, and postural instability 4 days after undergoing endoscopic sinus surgery for chronic sinusitis and nasal polyps. Computed tomography showed prominent intraventricular pneumocephalus causing enlargement of the anterior horns of both lateral ventricles with lateral displacement of the basal ganglia nuclei and a bony defect in the skull base. Neurosurgical correction of the cranial defect provided complete symptomatic resolution. Pneumocephalus as a result of an iatrogenic injury of the skull base manifesting as an acute movement disorder is a rare complication of a nasal sinus procedure. We speculate that compression of the caudate nucleus and striatum resulted in decreased pallidothalamic inhibition and thalamocortical disinhibition leading to the development of a hyperkinetic movement disorder. CONCLUSION: This unusual presentation of a common procedure illustrates a neurological emergency that requires prompt recognition and timely correction. Medknow Publications & Media Pvt Ltd 2018-09-21 /pmc/articles/PMC6169345/ /pubmed/30294497 http://dx.doi.org/10.4103/sni.sni_190_18 Text en Copyright: © 2018 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Unique Case Observations: Case Report Polster, Sean P. Obuobi, Shirlene Brutto, Victor J. Del Avner, Kenneth Markopoulou, Aikaterini Wong, Ricky H. An unusual presentation of dystonia and chorea from intraventricular pneumocephalus |
title | An unusual presentation of dystonia and chorea from intraventricular pneumocephalus |
title_full | An unusual presentation of dystonia and chorea from intraventricular pneumocephalus |
title_fullStr | An unusual presentation of dystonia and chorea from intraventricular pneumocephalus |
title_full_unstemmed | An unusual presentation of dystonia and chorea from intraventricular pneumocephalus |
title_short | An unusual presentation of dystonia and chorea from intraventricular pneumocephalus |
title_sort | unusual presentation of dystonia and chorea from intraventricular pneumocephalus |
topic | Unique Case Observations: Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169345/ https://www.ncbi.nlm.nih.gov/pubmed/30294497 http://dx.doi.org/10.4103/sni.sni_190_18 |
work_keys_str_mv | AT polsterseanp anunusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT obuobishirlene anunusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT bruttovictorjdel anunusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT avnerkenneth anunusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT markopoulouaikaterini anunusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT wongrickyh anunusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT polsterseanp unusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT obuobishirlene unusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT bruttovictorjdel unusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT avnerkenneth unusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT markopoulouaikaterini unusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus AT wongrickyh unusualpresentationofdystoniaandchoreafromintraventricularpneumocephalus |