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Traumatic pneumocephaly: trapped air from where?
  1. Azam Basheer1,
  2. Mohamed Macki2,
  3. Asim Mahmood2
  1. 1Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
  2. 2Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
  1. Correspondence to Dr Azam Basheer, abashee1{at}


Traumatic pneumocephaly is literally defined as ‘air in the head’ after trauma. While this phenomenon has been well described in the literature, our case report is unique in describing diffuse pneumocephalus in the subaponeurotic space, subdural space, subarachnoid space, brain and ventricles without a break in the cranial vault: a 26-year-old man fell from a =9 meter scaffolding in a water tower. Following an arduous and delayed extrication, the patient was unresponsive with loss of pulse requiring intubation, cardiopulmonary resuscitation and release of tension pneumothorax with bilateral thoracostomy tubes. Examination remained poor with a Glasgow Coma Scale of 3. Immediate exploratory laparotomy was performed for a small right retroperitoneal haematoma on Focused Assessment with Sonography for Trauma. Postoperative imaging revealed diffuse pneumocephaly without facial fractures. This case presentation explores unusual causes of fistulous connections with the atmosphere that may lead to air trapped in and around the cranial vault.

  • trauma
  • accidents, injuries
  • interventional radiology

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  • Contributors AB, MM and AM contributed to the conception and design of the work, as well as the acquisition, analysis and interpretation of data for the work. AB, MM and AM were all involved in drafting the manuscript as well as critical review and revision of the intellectual content. AB, MM and AM approved the final version of this submission and all are in agreement to be accountable for all aspects of the work and in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Institutional Review Board approval no 11145.

  • Provenance and peer review Not commissioned; externally peer reviewed.