title: Spontaneous pneumocephalus from nasal continuous positive airway pressure in a patient with ventriculo-peritoneal shunt.
abstract: Pneumocephalus in patients receiving positive airway pressure ventilation commonly occurs in the setting of trauma or surgery. We report a case of atraumatic pneumocephalus in a patient with a ventriculoperitoneal (VP) shunt on nasal continuous positive airway pressure (CPAP) for obstructive sleep apnoea. The patient presented with a 1-week history of "gurgling" sensation in his head and ataxia, with CT scan findings of a significant pneumocephalus. As extensive work up did not reveal any cause for his pneumocephalus, the nasal CPAP was thought to be the source. The CPAP was discontinued with improvement of the pneumocephalus, and resolution of his symptoms. He subsequently represented with recurrence of his symptoms, and increasing pneumocephalus on imaging. This was successfully managed by increasing his shunt pressure.
authors.affiliation: Department of Neurosurgery, The Austin Hospital, 145 Studley Rd., Heidelberg 3084, VIC, Australia. Electronic address: brianchee.mbbs@gmail.com.
authors.forename: Brian Nee Hou
authors.initials: BN
authors.lastname: Chee
authors.affiliation: Department of Neurosurgery, The Austin Hospital, 145 Studley Rd., Heidelberg 3084, VIC, Australia.
authors.forename: Muhammad Fahmi
authors.initials: MF
authors.lastname: Abdul Jalil
authors.affiliation: Department of Neurosurgery, The Austin Hospital, 145 Studley Rd., Heidelberg 3084, VIC, Australia.
authors.forename: Kristian John
authors.initials: KJ
authors.lastname: Bulluss
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000000981:diagnostic imaging*; D011007:Pneumocephalus / Q000000981:diagnostic imaging* / Q000209:etiology*; D019736:Prostheses and Implants / Q000009:adverse effects; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: Continuous positive airway pressure (CPAP); Pneumocephalus; Ventriculoperitoneal shunt