title: Spontaneous tension pneumocephalus resulting from a scalp fistula in a patient with a remotely placed ventriculoperitoneal shunt.
abstract: Tension pneumocephalus is a life-threatening condition that requires rapid recognition and intervention. It usually occurs as an early postoperative complication after neurosurgery or after trauma. Delayed tension pneumocephalus after ventriculoperitoneal shunt placement is unusual, with fewer than 50 published case reports, and is rarely caused by a scalp defect. We present a patient with nontraumatic tension pneumocephalus caused by a scalp fistula from a remote ventriculoperitoneal shunt placed 5 years earlier. This case is unique in that the patient underwent percutaneous aspiration of the tension pneumocephalus as a lifesaving procedure in the emergency department, with complete resolution of her symptoms at 30-day follow-up.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. jmonas@partners.org
authors.forename: Jessica
authors.initials: J
authors.lastname: Monas
authors.forename: David A
authors.initials: DA
authors.lastname: Peak
mesh_terms: D017577:Cutaneous Fistula / Q000150:complications / Q000209:etiology*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011007:Pneumocephalus / Q000209:etiology* / Q000601:surgery; D012535:Scalp; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*