Extensive tension pneumocephalus complicating continuous lumbar CSF drainage for the management of CSF rhinorrhoea

We report a case of tension pneumocephalus developing after a continuous lumbar CSF drain had been inserted for the treatment of CSF rhinorrhoea following translabyrinthine removal of a vestibular schwannoma. Despite conservative management, the patient developed recurrent CSF rhinorrhoea and hydrocephalus requiring explorations of the petromastoid cavity, an external ventricular drain and eventually a lumbar-peritoneal shunt. The prevention and management of pneumocephalus secondary to continuous lumbar CSF drainage is briefly reviewed.     

Otogenic pneumocephalus: case report and review of the literature

We report a case of a 70 year old lady who presented to the accident and emergency department with a three day history of left sided otalgia, drowsiness and confusion. On admission her temperature was 39 degrees C, glascow coma scale was 14/15 and otoscopy revealed a left sided otitis media. There was no sign of CSF otorrhoea or mastoiditis. Neuro-otological examination was normal. High resolution CT scan of temporal bones and brain showed evidence of pneumocephalus near the left cerebello-pontine angle and posterior to the left petrous bone. No focal parenchymal pathology, intra-cranial bleed or defect in the tegmen was noted. The patient responded very well to conservative management in the form of high dose intravenous antibiotics. We would like to emphasise that this complication of otitis media should be borne in mind when an elderly patient presents with otalgia and confusion.     

鼻内镜下脑脊液鼻漏修补术致张力性气颅一例

患者，男，24岁。于2003年3月7日因车祸致“右前额部颅骨骨折，脑挫裂伤”入住我院脑外科，行头皮清创缝合及脑外伤保守治疗23d后康复出院。仅在休息不好时出现轻度头疼。因“打喷嚏后出现右侧鼻腔持续性流清水伴头痛加重2d”于2003年4月14日以“脑脊液鼻漏”收住我科。     

Visual-field loss caused by sinusitis: a case report

The author reports a case of visual-field loss that was not characterized by any direct compression or external signs of sinus disease. The patient's hemianopia was found to be associated with severe sinusitis, which had not been clinically apparent and which had not extended beyond the bony walls of the sinuses. Following surgical drainage of the affected sinuses, the hemianopia resolved immediately and completely.     

Automastoidectomy caused by keratosis obturans: a case report

This is a case report of a 25-year-old Oriental woman with persistent and neglected keratosis obturans. The enlarging plug of keratin in the deep meatus produced an "automastoidectomy" in the left ear. The clinical findings are supplemented with a preoperative CT scan, and by pre- and postoperative Hopkins rod photographs of the ear. This case demonstrates dramatically the extensive erosion of bone that can occur in a patient with neglected keratosis obturans.     

嗅神经母细胞瘤引起尿崩症一例

嗅神经母细胞瘤（olfactory neuroblastoma,ONB）占鼻腔、鼻窦癌肿的6%,占整个上呼吸道、上消化道恶性肿瘤的0.3%,症状多不典型,以尿崩症为首发症状者罕见,我们于2004年4月诊治1例,经验和教训总结如下.     

Hemimacroglossia caused by isolated plexiform neurofibroma: a case report

OBJECTIVES: The present case is a diffuse isolated plexiform neurofibroma of the tongue that was not associated with neurofibromatosis that we treated with intraoral surgery. STUDY DESIGN: A case report. METHODS: We present a 5-year-old girl with isolated plexiform neurofibroma of the tongue with infiltration of the tongue base and review treatment approaches for this very rare tumor. RESULTS: An intraoral approach appears to be a good alternative method that allows both an acceptable exposure for total excision and limited postoperative sequelae. CONCLUSIONS: Isolated plexiform neurofibroma of the tongue is very rare. It causes a massive macroglossia that is progressive with advance of years and disturbs the patient's speech, occlusion, and tongue movements. Involvement of the tongue may be associated with infiltration into the deep structures of the neck by the tumor, thereby presenting considerable operative difficulties.     

Otitic hydrocephalus: case report and literature review

Otitic hydrocephalus is characterized by elevated intracranial pressure without focal neurologic abnormalities. The pathogenesis of otitic hydrocephalus remains unclear, but it usually occurs secondary to lateral sinus thrombosis. With the advent of new antibiotics, there has been a spectacular decrease in the complications of otitis media. Otogenic intracranial hypertension, always an uncommon condition, is seen only very rarely nowadays. Here we present a case of otitic hydrocephalus and discuss about its pathophysiology, clinical findings, and treatment.     

Olfactory and gustatory disturbances caused by digitalism: a case report

It is known that an overdose of digoxin causes visual disturbance, but the effect on the senses of smell and taste is not known. A case of olfactory and gustatory disturbance caused by digitalism is reported. In a 62-year-old male patient suffering from chronic digitalism, the serum digoxin level rose to 6.0 ng/ml. The patient was diagnosed not only with visual disturbance but also hyposmia and hypogeusia. The patient recovered from visual and chemosensory disturbances after the serum digoxin concentration returned to normal. Because the similarity of intracellular signal transduction between photoreceptor cells and olfactory and/or taste receptor cells is known, it is suspected that the influence of digoxin to chemosensory organs was caused by intermediation of sodium–potassium–adenosine triphosphatase (Na–K–ATPase) of the chemosensory receptor cells.     

Tension pneumocephalus: a case following otologic surgery

Asymptomatic pneumocephalus associated with cerebrospinal fluid drainage through a dural defect following extensive skull base surgery is not uncommon. Its occurrence following otologic surgery, however, is rare. Tension pneumocephalus, if not recognized, can rapidly lead to death due to increased intracranial pressure. A case of tension pneumocephalus is presented to demonstrate its clinical features and surgical management. The pathophysiology, diagnosis, and management of tension pneumocephalus are reviewed.     

Spontaneous otogenic intracerebral pneumocephalus: case report and review of the literature

Pneumocephalus is commonly associated with head and facial trauma, ear infection or surgical interventions. We describe the rare case of a spontaneous pneumocephalus arising from lateral mastoid air cells. A 48-year-old man presented with a 10-day history of sudden, repetitive, hammering-like acoustic sensations in his left ear that were followed by word-finding difficulties and loss of vision in the right visual field. Imaging revealed a large, left temporal pneumatocele associated with a small acute intracerebral hemorrhage. Left temporal and subtemporal craniotomy and decompression were performed. Further exploration confirmed a dural and osseous defect in the anterolateral surface of the mastoid that was consecutively closed watertight. Although extremely rare, a spontaneous pneumocephalus with mastoidal origin should be considered as a possible diagnosis in patients with suggestive acoustic phenomena and other non-specific neurological symptoms.     

Dix-Hallpike试验并发腰椎骨折一例

老年女性,因“反复阵发性眩晕5 d”就诊于北京京煤集团总医院,耳鼻咽喉科门诊拟完善变位试验以明确良性阵发性位置性眩晕诊断,行Dix-Hallpike试验过程中并发腰椎骨折,后转入骨科手术治疗。鉴于有研究表明中老年女性原发性良性阵发性位置性眩晕和骨质疏松之间存在明显相关性,因此对老年女性患者要慎重选择变位试验及手法复位。     

啮蚀艾肯菌致鼻咽颅底感染1例报道

目的 总结1例啮蚀艾肯菌引起鼻咽颅底感染的诊疗经验,提高对该菌感染病的认识。方法 回顾性分析1例啮蚀艾肯菌致鼻咽颅底感染患者的病例资料,并结合文献进行讨论。结果 本例患者完善内镜检查、影像学检查以及实验室检查,鼻咽颅底组织2次病理报告均为慢性肉芽肿性炎,经实验室确诊为啮蚀艾肯菌感染,予清创引流、口服抗生素2个月后,患者痊愈,术后随访3个月未复发。结论 鼻咽颅底感染临床少见,临床症状、影像学检查与鼻咽癌相似。啮蚀艾肯菌为罕见致病菌,发病率低。诊治上,需结合病理学、病原学检查明确诊断,及早清创引流、选取合适的抗感染药物。     

继发于副鼻窦炎的急性视神经炎一例

正患者女,48岁,于2016年1月13日收入我院。患者入院前10 d无明显原因出现左眼痛及左侧头痛,伴双眼视物模糊,无明显发热,于当地诊所给予抗炎药物(具体不详)静滴后未见明显好转,遂来我院就诊。既往"2型糖尿病"病史3年,自用"二甲双胍"控制。无眼外伤及其他全身病史。     

鼻内镜取除巨大鼻石1例

患者,男,68岁。因右鼻鼻塞、流脓涕10年入院,患者3年前曾在本市下级医院耳鼻咽喉科就诊,发现右鼻腔有"石头样"物,给予取出后鼻腔通气一度好转,术后3个月再次出现上述症状,呈持续性鼻塞,偶有鼻出血,出血量不多,能自行停止。病程中嗅觉有下降,无头痛,饮食、睡眠大小便正常。体检:一般情况好,外鼻无畸形,鼻中隔右偏,右侧总鼻道内见表面呈黑色、有异味、质地坚硬"新     

隐匿性结核感染导致喉软骨萎缩1例

目的 分析喉结核的临床特点及诊治要点.方法 回顾性分析上海交通大学医学院附属第九人民医院收治的1例隐匿性喉结核患者的临床资料,整理诊治经过,并结合相关文献复习.结果 患者以反复咽痛、声嘶起病,迁延10年,逐渐导致以会厌萎缩为特征的喉软骨病变.经完善检查排除肿瘤及自身免疫性相关疾病,符合结核感染特征,经抗结核治疗喉部黏膜...