Pneumocephalus from brachial plexus avulsion: A case report

Brachial plexus injury and pneumocephalus are both commonly encountered by neurosurgeons when consulted on victims of polytrauma. Historically there was no direct connection between these two conditions, however, the patient in this report demonstrates a potential link. An 18-year-old sustained a brachial plexus avulsion injury and a concurrent chest wall injury causing air to leak into his mediastinum which was treated with a chest tube. The patient developed pneumocephalus without an associated skull base fracture or other common cause. We describe a pathway where air in the mediastinum can enter the cerebrospinal fluid space through a tear in the dura caused by the nerve root avulsion. The air can then travel from the spine to the cranial vault causing pneumocephalus. Although this is likely to be a rare occurrence, the relationship between brachial plexus injury and pneumocephalus provides yet another neurologic condition to be aware of when caring for patients with brachial plexus injuries.

Duke Scholars

Author Brandon Wayne Smith Neurosurgery