Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Abstract

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.

Delayed Posttraumatic Tension Pneumocephalus: A Rare Case Report and Review of the Literature

“…The most common etiology by far was trauma. Similar to our case, Pillai et al [5] reported that frontal bone/sinus fracture is the most common injury associated with traumatic TP. Nineteen cases were picked up by CAT scans and one by MRI.…”

“…Pillai et al [5] conducted a comprehensive review of all reported cases of traumatic TP in the literature and identified 20 of such cases. In their review, there were 17 males and three females.…”

“…It is readily available and quite sensitive. It can detect as little as 0.5 mL of air compared with at least 2 mL that can be detected by plain skull imaging, which is an outdated option with which to investigate head trauma [5,13].…”

“…This will eventually lead to the appearance of significant neurological deficit if not treated promptly. By contrast, simple PNC is usually asymptomatic and requires no intervention [4][5][6].…”

Post Craniotomy Late Fuji Mountain Pneumocephalus: Case Report

“…The best way to diagnose this complication by CT scan of the brain is without injecting. Treatment includes craniotomy, extra air discharge in the brain, finding the location of air penetration (depending on the type of surgery), choosing air with water, and using intracranial controlling drugs (9).…”