Traumatic Frontal Bone Fracture Resulting in Intracerebral Pneumocephalus

Although traumatic pneumocephalus is not uncommon, it rarely evolves into tension pneumocephalus (TP). Characterized by the presence of increasing amounts of intracranial air and concurrent appearance or worsening neurological symptoms, TP can be devastating if not recognized and treated promptly. We present two cases of traumatic TP and a concise review of literature on this topic. Two cases of traumatic TP are presented. In addition, a literature search revealed 20 additional cases, of which 18 had sufficient information for inclusion. Literature cases were combined with the 2 reported cases and analyzed for demographics, mechanism of injury, symptoms, time to presentation (acute <72 h; delayed >72 h), diagnostic/treatment modalities, and outcomes. Twenty cases were analyzed (17 males, 3 females, median age 26, range 8–92 years). Presentation was acute in 13/20 and delayed in 7/20 patients. Injury mechanisms included motor vehicle collisions (6/20), assault/blunt trauma to the craniofacial area (5), falls (4), and motorcycle/ bicycle crashes (3). Common presentations included depressed mental status (10/20), cerebrospinal fluid rhinorrhea (9), headache (8), and loss of consciousness (6). Computed tomography (CT) was utilized in 19/20 patients. Common underlying injuries were frontal bone/sinus fracture (9/20) and ethmoid fracture (5). Intracranial hemorrhage was seen in 5/20 patients and brain contusions in 4/20 patients. Nonoperative management was utilized in 6/20 patients. Procedural approaches included craniotomy (11/20), emergency burr hole (4), endoscopy (2), and ventriculostomy (2). Most patients responded to initial treatment (19/20). One early and one delayed death were reported. Traumatic TP is rare, tends to be associated with severe craniofacial injuries, and can occur following both blunt and penetrating injury. Early recognition and high index of clinical suspicion are important. Appropriate treatment results in improvement in vast majority of cases. CT scan is the diagnostic modality of choice for TP.Republished with permission from:Pillai P, Sharma R, MacKenzie L, Reilly EF, Beery II PR, Papadimos TJ, Stawicki SPA. Traumatic tension pneumocephalus: Two cases and comprehensive review of literature. OPUS 12 Scientist 2010;4(1):6-11.

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“…A comprehensive summary of literature sources utilized in this report. [1234578915313233343536373839]…”

Section: Discussionmentioning

confidence: 99%

“…[1] Its pathophysiology involves air entry into the cranial cavity following injury to the brain meninges. [2] Tension pneumocephalus (TP) is a clinical entity characterized by continued buildup of air within the cranial cavity, leading to abnormal pressure exerted on the brain and subsequent neurologic deterioration.…”

Section: Introductionmentioning

confidence: 99%

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Pillai

Sharma

MacKenzie

et al. 2017

Int J Crit Illn Inj Sci

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“…However, this has largely been superseded with the advent of CT. Air has a Hounsfield coefficient of −1000 on CT, which enables the sensitive and specific detection of even minute quantities of intracranial air; 0.5 mL of air can be visualized with CT in contrast to 2 mL, which is the minimum that can be seen with plain films [9]. However, CT is only performed in patients with clinical indications and in combination with local guidelines.…”

Section: Discussionmentioning

confidence: 99%

“Head to Head”: pneumocephalus as a complication of soccer

2013

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BackgroundPneumocephalus is uncommon in craniofacial trauma and a rare occurrence in non-contact sports. It may be asymptomatic or present with signs of increased intracranial pressure and the majority of cases will resolve with conservative management. However, there should be a high index of clinical suspicion to recognise, diagnose, and manage it appropriately, as complications may be fatal.FindingsTo our knowledge, this is the first case report of pneumocephalus secondary to a “minor” head injury during a soccer match.ConclusionWe outline the management of this condition and highlight signs that should generate a high index of suspicion.

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“…[2] The most common cause of pneumocephalus is head trauma that leads to fracture of the base of the cranium. [3][4][5] Besides, craniofacial operations, transsphenoidal surgery, ventriculoperitoneal shunt procedures, posterior fossa operations in sitting position, lumbar drainage, spinal anesthesia, lumbar punctures and operations for chronic subdural hematoma can also cause pneumocephaly. [6,7] In our patient, tension pneumocephaly developed in the immediate period following orbital roof fracture.…”

Section: Discussionmentioning

confidence: 99%