Abstract
A case of tension pneumocephalus associated with the use of nitrous oxide as an anesthetic agent for surgery is reported.
The patient was a 30-year-old male, admitted with multiple injuries caused by a traffic accident. On admission, his consciousness was slightly disturbed but no other neurological deficits were assessed. The computerized tomography (CT) scan revealed a small amount of air in the frontal subdural and intracerebral spaces. A skull X-ray showed a short linear fracture on the frontal bone. A basal skull fracture was suspected by clinical findings but was not comfirmed by X-ray examination. Six hours after an operation for open fractures of tibia and fibra under general anesthesia with 66% nitrous oxide, neurological deficits suddenly occurred. A CT scan and a skull X-ray showed a marked increase in the size of the subdural air. Twelve hours later, the air diminished according to a follow-up X-ray and the neurological deficits gradually decreased spontaneously. A CT scan on the 4th hospital day showed no intracranial air collection.
In this case the use of nitrous oxide was suspected to play an important role in the genesis of tension pneumocephalus. It was concluded that the use of nitrous oxide should be avoided in the cases of multiple injuries with basal skull fractures.
