Adult Female With Head Injury

Diagnosis 

Traumatic tension pneumocephalus. Defined as progressive air-trapping in the cranium, causing mass effect and neurologic deficits, tension pneumocephalus is a rare adverse effect of craniofacial trauma.1 Although 75% of cases result from acute trauma, other causes include tumors, infection, surgery, spinal anesthesia, and positive pressure ventilation.2 Development of early traumatic tension pneumocephalus is virtually diagnostic for a craniofacial fracture, whereas late or nontraumatic development is suggestive of a continual cerebrospinal fluid leak or fistula.3

Tension pneumocephalus can be distinguished from simple pneumocephalus on CT by the Mount Fuji sign4 (Figure 4), identified as bilateral frontal lobe compression with interhemispheric separation resembling Mount Fuji's volcanic peak. Untreated, tension pneumocephalus can lead to cognitive impairment, cerebral ischemia, herniation, coma, and death. Treatment ranges from supine bed rest to craniotomy. The most common reported emergency department interventions are burr holes, needle aspiration, and medical intracerebral pressure reduction.1