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Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after b...

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Autores principales: Lee, Jaekyoung, Lee, Dong Cheol
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154941/
https://www.ncbi.nlm.nih.gov/pubmed/34035023
http://dx.doi.org/10.1136/bcr-2020-241540
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author Lee, Jaekyoung
Lee, Dong Cheol
author_facet Lee, Jaekyoung
Lee, Dong Cheol
author_sort Lee, Jaekyoung
collection PubMed
description Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.
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spelling pubmed-81549412021-06-10 Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient Lee, Jaekyoung Lee, Dong Cheol BMJ Case Rep Case Report Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR. BMJ Publishing Group 2021-05-25 /pmc/articles/PMC8154941/ /pubmed/34035023 http://dx.doi.org/10.1136/bcr-2020-241540 Text en © BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Case Report
Lee, Jaekyoung
Lee, Dong Cheol
Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient
title Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient
title_full Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient
title_fullStr Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient
title_full_unstemmed Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient
title_short Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient
title_sort delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154941/
https://www.ncbi.nlm.nih.gov/pubmed/34035023
http://dx.doi.org/10.1136/bcr-2020-241540
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