Tension Pneumocephalus in a Posttraumatic Patient: Computed Tomographic Findings and Case Report

Tension pneumocephalus is an unusual bad life-threatening neurosurgical emergency, this is the equivalent of tension pneumothorax. This often follows head trauma, epidural injections, complicating neurological spinal, craniofacial or sinus surgery. This is a forty-five-year-old man that was involved in a road traffic accident, was referred for a computed tomography of the brain on account of altered consciousness, irrational behavior, and restlessness. A non-contrast enhanced computed tomography of the brain was done, this demonstrated multiple areas of cortical discontinuity in the facial and skull vaults in keeping with fractures, extensive negative density (HU: -968) hypodensity in the frontal region bilaterally causing marked inferior displacement of both frontal lobes of the brain, with associated splaying of the interhemispheric fissure likened to the ‘Mount Fuji sign’ of severe/tension pneumocephalus. Pockets of negative density hypodensities are also noted in both cerebral hemispheres in keeping with pneumatoceles are also demonstrated. Generalized effacement of sulci and gyri in keeping with cerebral edema is also demonstrated. The outcome of the patient in the peripheral center was not known as at the time of this report, because all effort to get across to the patient and relations proved abortive. We present a case of tension pneumocephalus following road transport accident, to review the computed tomographic features due to its peculiar presentation.