Trauma-Associated Tension Pneumocephalus with Characteristic Mount Fuji Sign—Case Report (original) (raw)
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Traumatic tension pneumocephalus: a case report and perspective from Indonesia
Frontiers in neurology, 2024
Traumatic tension pneumocephalus is a rare and life-threatening complication of traumatic brain injury necessitating prompt diagnosis and neurosurgical treatment. Nevertheless, various possibilities for impedance in timely management, including patient-related barriers are commonly experienced in low-and middle-income countries setting. Here we presented a delay of management in traumatic tension pneumocephalus case due to initial refusal for emergency surgery. A 59-year-old male presented to the emergency department following a motorcycle accident fully alert with no neurological deficit. He acknowledged clear nasal discharge within 1 h after the initial trauma, but no rhinorrhea or otorrhea was present during physical examination. Head CT revealed extensive pneumocephalus with "Mount Fuji sign," anterior skull base fracture, and frontal sinus fracture. The patient initially refused immediate surgical intervention due to excellent clinical condition and financial scare. Acute decrease of consciousness occurred 40 h post-trauma: GCS of 6 with slight dilatation of both pupils (4 mm) and sluggish pupillary reflex. Emergency bifrontal craniotomy, subdural air drainage, and dura mater tear repair were performed afterwards. Postoperative care was uneventful, with rapid improvement of consciousness and follow-up head CT showing minimal subdural fluid collection and absence of remaining pneumocephalus. The patient was discharged from the hospital after 7 days with GCS of 15 and GOS of 5, proving the importance of overcoming barriers for delay in delivering neurotrauma care in low-and middle-income countries.
Traumatic tension pneumocephalus: Two case reports
International Journal of Surgery Case Reports, 2017
INTRODUCTION: Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly. CASE PRESENTATION: We presented two cases of post-traumatic tension pneumocephalus. A 30-year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43-year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury. CONCLUSIONS: These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.
Traumatic tension pneumocephalus: A series of 4 cases managed in Zaria
2016
Tension pneumocephalus is the accumulation of air in the intracranial cavity with attendant neurological changes. Though a neurosurgical emergency, it could present in a delayed form requiring a high index of suspicion. We report a series of four cases; two of which were managed operatively and two non-operatively with good outcome. Keywords : Aerocele, imaging, otorrhoea, outcome, rhinorrhoea, trauma
Posttraumatic delayed tension pneumocephalus: Rare case with review of literature
Asian Journal of Neurosurgery, 2016
Aim: Tension pneumocephalus is a problem that requires emergent intervention for the fact that it can lead to sudden increase in intracranial pressure. In this study we present a case of late tension pneumocephaly which threatened the life of the patient. Subject: A 63-year-old man was admitted to our emergency unit with severe headache after being involved in a traffic accident. Radiological exams showed frontal sinus fracture, frontal cerebral contusion and minimal pneumocephalus. Conservative treatment was initiated. On the eleventh day he had a disturbance in consiousness, hence another cranial computerized tomography was taken which revealed subdural, intraventricular and intraparenchymal tense air that caused high pressure on the brain and intracranial areas including the posterior fossa. The patient was operated on urgently and the tense air was evacuated. During the postoperative period the patient's state of conscious began to improve. Result: In view of this situation, although tension pneumocephaly generally develops during the early posttraumatic period, it should be kept in mind that it can also develop in the late phase. So long-term, close observation for the patients with simple pneumocephaly is beneficial.
Does the Mount Fuji Sign always signify ‘tension’ pneumocephalus? An exception and a reappraisal
European Journal of Radiology Extra, 2011
Pneumocephalus is expected after any craniotomy and usually resolves without any sequelae. However if the air entering the cranial cavity gets entrapped, it can lead to tension pneumocephalus and can have disastrous consequences. It is of utmost clinical importance to differentiate a tension pneumocephalus from a non-tension pneumocephalus as the latter does not usually require decompressive surgery. CT scan is considered the gold standard and diagnostic modality of choice for the diagnosis of pneumocephalus in the post-operative period. The Peaking sign and Mount Fuji sign are proposed as fairly specific for tension pneumocephalus, the latter being the most specific and an important sign to differentiate it from nontension pneumocephalus. We present a case of a 20 year old male whose post-operative CT brain showed the typical Mount Fuji sign suggestive of tension pneumocephalus but was managed conservatively without any decompressive surgery.
2020
Tension pneumocephalus (TPC) is a neurosurgical emergency that occurs when there is an expansion of trapped intracranial gas causing raised intracranial pressure. Rarely, posttraumatic TPC can occur even after 72 hours although the initial scans are normal. There are less than 20 cases of delayed TPC in the reported literature. Here, we report a case of delayed TPC that occurred 7 days after the initial injury and presented as sudden neurological deterioration. It was promptly diagnosed with a computed tomography brain and appropriate surgical intervention was performed and the outcome was good. We also did a literature review of reported cases of delayed TPC and looked out for factors that may predict its occurrence. The occurrence of an episode of cerebrospinal fluid rhinorrhea, followed by worsening of headache and sensorium in a patient with anterior cranial fossa fracture should alert a neurosurgeon to the possibility of delayed TPC.
Pneumocephalus After Traumatic Head Injury
Neurosurgery Quarterly, 2015
Objective: The objective of the study was to outline the demographic, clinical, and radiologic features of traumatic pneumocephalus (TP) and to establish the parameters that may be associated with morbidity and mortality. Methods: A total of 73 TP patients (16 females, 57 male) with an average age of 32 years (range, 2 to 80 y) treated conservatively in the neurosurgery department of a tertiary care center were included in the study. Demographics, etiology, and location of TP, site of cranial fractures, occurrences of rhinorrhea, otorrhea, and meningitis, Glasgow Coma Scale, duration of hospitalization, and other parameters related to morbidity and mortality were investigated. Results: The most common cause of TP was traffic accidents (38.4%), and frontal (47.9%) and temporal (35.7%) lobes were affected most frequently. Incidences of meningitis and convulsion after TP were 8.4% and 12.3%, respectively. Otorrhea/rhinorrhea accompanied 80% of TP cases with meningitis, and patients with meningitis seemed to be hospitalized for a longer period. The mortality rate was 20% in TP patients with meningitis. In two thirds of cases, pneumocephalus was detected in epiduralsubdural-subarachnoid or subarachnoid-intraparenchymal locations. Subdural hemorrhage and contusion accompanied TP in 22% of our patients. Conclusions: Our results indicate that TP can be treated medically in a vast majority of patients. Precautions and effective treatment against meningitis is crucial for minimizing morbidity and mortality in TP. Regression of pneumocephalus and recovery in terms of the neurological state can be followed closely with the Glasgow Coma Scale.