Article Text
Statistics from Altmetric.com
A healthy 69-year-old man was hit by a car while bicycling. On admission, he was vomiting but had a maximal Glasgow Coma Score, and no other abnormalities on neurological examination. Trauma screening suggested fractures of the left zygomatic arch, the left orbita (floor and wall), the left and right temporal bone, the right maxilla and scull base fracture. This was confirmed by a cranial CT scan of the brain (fig 1, top panel), that also revealed a pronounced widespread pneumocephalus. Pneumocephalus differs radiologically from the more frequently observed extracerebral localised air collections. The latter may lead in only a very few patients to the rare “Mount Fuji sign”1 whereas this has never been observed in patients in pneumocephalus.
The patient made an uneventful clinical recovery within weeks, which was in line with the striking improvement of a follow-up CT (fig 1, bottom panel).
COMMENT
Pneumocephalus usually presents with nausea and vomiting, seizures, deterioration and dizziness.2 It can be caused by trauma, infections or barotraumas.3 A pneumocephalus usually does not require treatment, unless a symptomatic tension pneumocephalus develops, which may require evacuation.4
Acknowledgments
This article has been adapted from Bartholomeus M G T, de Leeuw F E. “Bubbling brain” Journal of Neurology, Neurosurgery and Psychiatry 2008;79:671
Footnotes
Competing interests: None.