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LETTER TO EDITOR
Year : 2023 | Volume
: 71
| Issue : 5 | Page : 1082-1083
Delayed Tension Pneumocephalus Following Traumatic Brain Injury: A Rare Entity
Nandakumar Poonthottam1, Ramkumar Menon2
1 General Practitioner, Thrissur, Kerala, India
2 Atreya Hospital, Thrissur, Kerala, India
Correspondence Address:
Nandakumar Poonthottam
Mangalam, Malappuram, Kerala, 676 561
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/0028-3886.388070
How to cite this article:Sir,
Delayed tension pneumocephalus is characterized by a continuous buildup of air within the cranial cavity over more than 72 h, leading to abnormal pressure exerted on the brain and subsequent neurologic deterioration.[1],[2] The authors are reporting a unique case of delayed tension pneumocephalus following a remote head injury.
A 23-year-old male patient presented with a chief complaint of left-sided weakness that had been progressively worsening over 1 month. The patient had a history of head injury 3 months ago, for which he received treatment at a local hospital. He was conscious, alert, and oriented with the Glasgow coma scale (GCS) of 15/15. His computed tomography (CT) at that time revealed evidence of bilateral basifrontal contusions and fracture of frontal and nasal bones. He was managed conservatively and discharged subsequently.
He presented in our neurosurgical outpatient with a history of left hemiparesis. On examination, the patient was conscious and oriented and had a GCS score of 15/15. Neurological examination showed power in the left upper and lower limb grade 4/5 of the Medical Research Council (MRC), left hyporeflexia, and ataxic gait. Power in the right upper and lower limbs was found to be 5/5 of MRC. Pupils were bilaterally equal and reactive to light, cranial nerves were within normal limits, sensations were intact, and no meningeal signs were observed.
A computed tomography (CT) scan of the brain demonstrated a large pneumocephalus in the right frontal region, causing a mass effect on the surrounding neuroparenchyma [Figure 1]. Multiple fractures involving the frontal sinus were observed bilaterally. The fracture on the right side specifically involved the posterior table of the frontal sinus, creating a communication pathway with the pneumocephalus [Figure 2]. Consequently, the patient underwent a right frontal craniotomy for the repair of the frontal sinus under general anesthesia. The sinus was exteriorized using a galeal flap. The procedure was uneventful, the patient received treatment with antiepileptics, antibiotics, anti-edematous agents, and other supportive measures.
Figure 1: Large pneumocephalus on the right frontal region, causing mass effect on the surrounding neuroparenchyma
Figure 2: Sagittal CT bone window showing communication between frontal sinus and pneumocephalus extending posteriorly and superiorlyA follow-up CT scan was taken 3 days after the surgery, which revealed a significant decrease in the size of the pneumocephalus and resolution of the mass effect on the adjacent brain tissue [Figure 3]. Moreover, the communication between the pneumocephalus and the right frontal sinus was no longer evident. CT scan is the most effective method for diagnosing pneumocephalus, as it can detect even small amounts of air as low as 0.5 mL.[2],[3] Last follow-up of the patient was 5 months post-surgery and he continues to remain asymptomatic.
Figure 3: Significant decrease in the size of the pneumocephalus and resolution of the mass effect on the adjacent brain tissueDeclaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Nil.
Conflicts of interest
There are no conflicts of interest.
References
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