Abstract
Background
Traumatic tension pneumocephalus is a rare complication after craniofacial fractures
that can cause devastating neurologic deficits if not managed promptly and effectively.
Case Report
A 38-year-old man with no past medical history presented to the Emergency Department
(ED) after a motor vehicle crash. He was noted to have an open frontal scalp laceration.
Computed tomography (CT) revealed a right frontal subdural hematoma and right medial
frontal contusion. There was also a frontal bone fracture extending through the frontal
sinus with mild underlying pneumocephalus. He was monitored for cerebrospinal fluid
(CSF) leak and was subsequently discharged on postinjury day 9. He re-presented to
the ED 14 days post injury with lethargy, confusion, headache, and swelling around
his scalp laceration. A CT scan was obtained that revealed a large-volume intraparenchymal
pneumocephalus (pneumocerebri) with mass effect and midline shift. The patient was
started on 100% oxygen and admitted to the intensive care unit. He was taken to the
operating room for evacuation of the pneumocerebri, repair of dural defect, placement
of a vascularized pericranial graft, and placement of a lumbar drain. His lumbar drain
was removed on postoperative day 3 and he was discharged home neurologically intact
on postoperative day 6. At 1 month follow-up he had no evidence of CSF leak and was
neurologically intact.
Why Should an Emergency Physician Be Aware of This?
This case is presented to increase awareness among emergency physicians that traumatic
tension pneumocephalus, and in this case, pneumocerebri, is a rare life-threatening
neurosurgical emergency in patients with severe craniofacial fractures after blunt
or penetrating head trauma. Early temporizing measures in the ED, such as 100% oxygen
via nonrebreather face mask, and urgent neurosurgical consultation are indicated to
prevent neurologic deterioration.
Keywords
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References
- Pneumocephalus due to nasopharyngeal carcinoma: case report.Neuroradiology. 1996; 38: 70-72
- Subdural tension pneumocephalus following surgery for chronic subdural hematoma.J Neurosurg. 1988; 68: 58-61
- The Mount Fuji sign.Radiology. 2004; 232: 449-450
- Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus.J Neurosurg. 2008; 108: 926-929
- Frontal sinus fractures: current concepts.Craniomaxillofac Trauma Reconstr. 2009; 2: 161-175
- Tension pneumocephalus following head injury.Emerg Med J. 2006; 23: 324
- Aeromeical evacuation of patients with pneumocephalus: outcomes in 21 patients.Aviat Space Eniron Med. 2008; 79: 30-35
Article info
Publication history
Published online: September 08, 2020
Accepted:
August 2,
2020
Received in revised form:
May 6,
2020
Received:
October 14,
2019
Identification
Copyright
Published by Elsevier Inc.
