title: Postsurgical pneumoencephaly in a patient with Klippel-Feil syndrome.
abstract: A 49-year-old woman presented with occipital headaches, dizziness, photophobia and vomiting for 2 weeks' status post posterior scalp mole removal by a general surgeon. The physical examination revealed occipital lesions with foul smelling purulent discharge mixed with clear fluid drainage, webbed neck with decreased range of motion, facial asymmetry and a low posterior hairline. A CT of head showed occipital skull defect providing a communicating pathway for scalp infection, an atlas fusion defect and an extensive pneumoencephaly. Further imaging showed low-lying cerebellar tonsils and fusion of the body of second and third cervical vertebrae. Klippel-Feil syndrome was diagnosed and the patient was successfully managed with duraplasty of occipital dura, placement of a lumbar drain and antibiotics. In patients with findings suggestive of Klippel-Feil syndrome and lesions proximal to the CNS, appropriate neuroimaging and possible neurosurgical consult should be considered prior to any surgical intervention.
authors.affiliation: Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA.
authors.forename: Nasir
authors.initials: N
authors.lastname: Hussain
authors.forename: Pavani
authors.initials: P
authors.lastname: Thotakura
authors.forename: Roger A
authors.initials: RA
authors.lastname: Lichtenbaum
authors.forename: Aibek E
authors.initials: AE
authors.lastname: Mirrakhimov
mesh_terms: D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007714:Klippel-Feil Syndrome / Q000150:complications*; D008875:Middle Aged; D009506:Nevus / Q000601:surgery*; D011007:Pneumocephalus / Q000175:diagnosis / Q000209:etiology*; D012535:Scalp / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D013530:Surgical Wound Infection / Q000150:complications*