Pneumocephalus after craniotomy will absorb within four weeks, but when air causes pressure affects it is a tension pneumocephalus, which may affect consciousness and requires immediate intervention. Tension pneumocephalus causing cerebral sinus thrombosis is not known in the literature. We report a case of tension pneumocephalus causing diabetes insipidus associated with cerebral sinus thrombosis.
A 38-year-old Asian male had craniotomy with excision of a left frontal mass which extended into the lateral ventricles. External ventricular and subdural drains were inserted at the end of the procedure. He received mannitol and furosemide intraoperatively. Immediately after surgery he developed tension pneumocephalus, diabetes insipidus and fever. Two days after surgery, magnetic resonance imaging (MRI) showed transverse, sagittal sinus thrombosis extending into the right internal jugular vein. Pre-operative MRI and thrombophilia markers were unremarkable. Cerebrospinal fluid (CSF) analysis did not demonstrate leucocytosis and did not culture bacteria. Anticoagulation was initiated, but on the third day after surgery he developed severe brain swelling and became brain-dead.
In our patient tension pneumocephalus was complicated by diabetes insipidus and leading to cerebral sinus thrombosis after surgery.