jneuroJournal of Neurology and NeuropsychiatrycoVolume 1 Issue 2 (July-Dec)MultidisciplinaryEnglish6 Months NNY2024112NeurosurgeryAnother Idiopathic Case of Pneumocephalus: Spontaneous or Retrograde?EnglishY1113Aderonke Oyetunji1EnglishNBinodWagle1EnglishY2EnglishYIntroduction: Pneumocephalus is a rare phenomenon, typically resulting from traumatic or non-traumatic causes. It could however occur spontaneously, in the absence of an underlying condition or from manipulation of a venous catheter resulting in retrograde movement of air against the direction of blood flow causing fatality. It occurs in less than 3 per 100,000 hospitalizations . This case reports possible etiologies of a rare case of pneumocephalus resulting in a stroke. Materials and Methods: A review of chart and verbal consent from patient’s family prior to reporting case.Results and Discussion: We present a 76-year-old African American female with End Stage Renal Disease who presented to the ED for altered mental status, following an episode of bleeding during a hemodialysis (HD) completed via the internal jugular vein through a tunneled dialysis catheter. Neurological examination revealed signs of a massive stroke including a right lateral gaze, with 3+ reflexes in the upper extremities bilaterally. Head CT scan revealed moderate amounts of air within the right frontoparietal sulci, minute intraparenchymal foci of gas within the venous structures; interval gray-white loss involving the right frontoparietal lobe and right centrum semiovale, with watershed involvement. Echo cardiogram revealed no wall or valvular defect. She was not deemed appropriate for Hyperbaric oxygen and discharged to a palliative care facility by family. Conclusions: While some causes of pneumocephalus have previously been documented in literature, unusual etiology can lead to diagnostic dilemma and calls for a high level of suspicion by healthcare providersEnglishtraumatic, stroke, Pneumocephalushttps://jneuro.clsconf.com/admin/abstract?id=26References1619Wang, H.Y.; Li, T.; Li, X.L.; Zhang, X.X.; Yan, Z.R.; Xu, Y. Anti-N-methyl-D-aspartate receptor encephalitis mimics neuroleptic malignant syndrome: Case report and literature review. Neuropsychiatr. Dis. Treat. 2019, 15, 773and;ndash;778. doi:10.2147/NDT.S201234. Google Scholar | PubMedMarkham, J.; Hughes, B. Spontaneous pneumocephalus in the absence of trauma: Case report and review. J. Clin. Neurosci. 2018, 53, 106and;ndash;110. doi:10.1016/j.jocn.2018.03.015. Google Scholar | PubMedKumar, A.; Sharma, P.; Singh, R. Retrograde cerebral air embolism following central venous catheter insertion: A rare complication. Int. J. Crit. Illn. Inj. Sci. 2020, 10(2), 85and;ndash;89. doi:10.4103/IJCIIS.IJCIIS_23_20. Google Scholar | PubMedHarris, M.; Lee, J.; Patel, V. Iatrogenic pneumocephalus: Mechanisms, diagnosis, and management. J. Neurosurg. 2017, 126(5), 1457and;ndash;1465. doi:10.3171/2016.11.JNS16234. Google Scholar | PubMedChen, L.; Wang, X.; Zhang, Y. Incidence and outcomes of pneumocephalus in hospitalized patients: A retrospective analysis. BMC Neurol. 2016, 16, 142. doi:10.1186/s12883-016-0675-4. Google Scholar | PubMedOertel, J.M.; Baldauf, J.; Schroeder, H.W. Spontaneous pneumocephalus: Case series and literature review. Acta Neurochir. 2006, 148(12), 1313and;ndash;1317. doi:10.1007/s00701-006-0842-8. Google Scholar | PubMedKim, D.H.; Park, J.S.; Lee, S.H. Unusual causes of pneumocephalus after hemodialysis catheter placement: Case report. Neurocrit. Care 2019, 31(3), 626and;ndash;630. doi:10.1007/s12028-019-00723-1. Google Scholar | PubMedSteinberg, J.P.; Nguyen, H.T.; Roberts, C.A. Retrograde cerebral air embolism: Case series and review. J. Neurol. Sci. 2020, 415, 116915. doi:10.1016/j.jns.2020.116915. Google Scholar | PubMed