Vanishing traumatic pneumocephalus – An alarm bell for the surgeon

Roopak Dubey, Kamal Kumar Sen, Mayank Goyal, D Sindhu Reddy, Suma M K

Abstract


Pneumocephalus usually occurs because of a bony defect between the intracranial compartments and the paranasal sinus. We present a case of traumatic non tension pneumocephalus with accompanying subdural haemorrhage (SDH) and fractures of the roof of sphenoid sinus.We noticed complete resolution of pneumocephalus with in a day on repeat CT head done on the next day. Significant resolution of SDH was also noted. This was unexpected as usually it takes 2-3 weeks for the complete resolution of non tension
pneumocephalus. We assume that fracture in the roof of sphenoid sinus lead to CSF and haemorrhagic leakage through the sphenoethmoidal recess located within the superior meatus. This was unusual as CSF leakage is itself a cause of development of pneumocephalus when intracranial pressure is expected to
increases, according to Ball Valve theory. So, the resolution of pneumocephalus was before the development of sufficient intracranial pressure to cause Ball valve effect. Hence, a complete resolution of a significant pneumocephalus and prompt regression of SDH in head injuries, with in few hours, should raise an alarm to exclude the possible association of CSF rhinorrhoea.

Keywords: Pneumocephalus, CSF rhinorrhea, Subdural haemorrhage, 
Sphenoid roof fracture.


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