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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...

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Autores principales: Polster, Sean P., Obuobi, Shirlene, Brutto, Victor J. Del, Avner, Kenneth, Markopoulou, Aikaterini, Wong, Ricky H.
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
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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.
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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
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