Tension pneumocephalus: an uncommon cause of altered mental status

Abstract

Background: Pneumocephalus is a rare cause of altered mental status in patients presenting to the Emergency Department. Occurring as a result of traumatic or iatrogenic violation of the dura, it can cause significant morbidity and mortality if tension physiology develops whereby air continues to accumulate with no mechanism for escape.

Objective: This case report will review the underlying pathophysiology, clinical presentation, diagnosis, and management of tension pneumocephalus.

Case report: We present the case of an 89-year-old man who presented to the Emergency Department with declining mental status 9h after endoscopic sinus surgery. He was subsequently found to have tension pneumocephalus and underwent emergent burr hole evacuation. Despite resolution of the pneumocephalus, the patient had persistent neurologic deficits related to ischemic infarcts that occurred as a result of the tension physiology and subsequently expired in the hospital.

Conclusion: This case illustrates the importance of considering tension pneumocephalus on the differential diagnosis for any patient presenting with altered mental status after surgical or diagnostic procedures with potential to violate the dural space.