I CONGRESO DIGITAL AEP. Libro de comunicaciones y casos clínicos

1055 ISBN: 978-84-09-24491-1 ÁREA DE ESPECIALIDAD • URGENCIAS ASOCIACIÓN ESPAÑOLA DE PEDIATRÍA CASO CLÍNICO. Doctor, your patient has air inside the head! Madalena Meira Nisa, Jessica França Sousa, Ângela Gomes Almeida, Cristina Cravo Baptista Centro Hospitalar Tondela-Viseu, Viseu, Portugal INTRODUCCIÓN Pneumocephalus consists of an air accumulation in- side the intracranial cavity and it can exists in several compartments: extradural, subdural, subarachnoid, intraventricular and intracerebral. It is usually associ- atedwith firearm injuries, neurosurgery, barotrauma, basilar skull and nasopharyngeal tumor invasion, meningitis, basilar skull fractures and paranasal si- nuses fractures. Pneumocephalus may be seen in 0.5-1.0% of all cranioencephalic traumas. RESUMEN DEL CASO A 17 year-old boy, previous healthy, was admitted in the pediatric emergency with a cranioencephalic trauma occurred one hour before, during a football game (clash of the frontal region against the refer- ee). He presented frontal headaches, dizziness and epistaxis. Denied loss of consciousness, amnesia, somnolence or vomiting. On physical examination, he presented a 15 Glascow Coma Scale; erythema located in the impact zone; anterior and posterior epistaxis; neurological examination without changes. A skull radiography was performed and it showed air inside the intracranial cavity, so a cranioencephalic computed tomography (TC-CE) was also done re- vealing “recent fracture at the base of the left frontal sinus with extra-axial intracranial air component, with bilateral frontal expression”. After discussing the clinical case with the Pediatric Neurosurgery, prophylactic antibiotic (Ceftriaxone) and aminocap- roic acid were started and the patient was hospital- ized for analgesia, bed rest with head elevation of 30º and vigilance. He presented a favorable clinical evolution with complete resolution of the symptoms in 48 hours and, at the 4th day of hospitalization, he repeated a TC-CE revealing “practically total reab- sorption of intracranial air foci”. He was discharged with scheduled Pediatric Neurosurgery reevaluation. CONCLUSIONES Y COMENTARIOS Cranioencephalic trauma is themost important cause of pneumocephalus. The anatomy of the frontal bone and its proximity with the duramater predisposes the air entrance to the subdural region after trauma. The symptomatology is caused by increased intracranial pressure and is characterized by: frontal headache; seizures; loss of consciousness; nausea; vomiting; dizziness; hemiparesis. The duration and intensity of symptoms are directly related to the amount of intracranial air. TC-CE is the gold standart exam to diagnose and evaluate the extension of the pneumo- cephalus. The presence of air tends to regress spon- taneously with the conservative treatment applied in this clinical case, with no neurosurgical intervention inmost cases. There is no consensus in the literature regarding the use of prophylactic antibiotics, even in traumatic etiology. In conclusion, a complete physi- cal exam and adequate surveillance of all patients with cranioencephalic trauma is essential in order to detect intracranial lesions, such as the pneumo- cephalus.