Tension pneumocephalus with diplegia and deterioration of consciousness

Abstract

Tension pneumocephalus results from intracranial air under pressure as a rare complication after head injury or craniofacial surgery. A 58-year-old man underwent ethmoid sinus surgery and subsequently developed rapidly progressive global headache, restlessness, diplegia with sensory loss, and deterioration of the conscious level. A head CT demonstrated extensive pneumocephalus with gross compression of the brain. The frontal retention of air caused widening of the interhemispheric fissure leading to a peaked appearance of the frontal poles, referred to as the 'Mount Fuji sign'. Surgical revision of a dural air leak resulted in rapid improvement and full clinical resolution. Early diagnosis of tension pneumocephalus and emergent surgical treatment are crucial to prevent life-threatening deterioration.

Keywords: Diplegia; Emergency; Mount Fuji sign; Tension pneumocephalus.

Fig. 1

Entry of air through a bony defect (arrow) leading to compression of the brain (a). Frontal accumulation of air causing widening of the interhemispheric fissure (b).