Post-traumatic epidural tension pneumocephalus: a case report

Abstract

Introduction: Pneumocephalus is usually a self-limiting condition commonly associated with neurosurgical interventions, head and facial trauma. In contrast, tension pneumocephalus is extremely rare, and considered a neurosurgical emergency.

Case presentation: We present a rare case of post-traumatic epidural tension pneumocephalus in a 30-year-old white man who deteriorated rapidly after a blunt head trauma. Imaging revealed a large, right temporoparietal epidural pneumocephalus with mass effect, most likely arising from a small defect in the mastoid sinus. A pre-existing mucocele was also suspected. Emergency burr hole evacuation was performed and he experienced full recovery, but more invasive treatment was eventually needed to resolve the condition.

Conclusions: Epidural tension pneumocephalus is a rare and potentially life-threatening condition, but treatable with the right management. To the best of our knowledge, a post-traumatic tension pneumocephalus caused by a pre-existing mucocele has not been reported in the literature.

Fig. 1

Imaging with computed tomography of the head revealed a 10cm×4cm expansive epidural lesion in the right temporoparietal region causing significant anteromedial compression of the right lateral ventricle and a midline shift of 7mm (a and b). A communication between the right mastoid sinus and the epidural space caused by a fracture was suspected (c). Postoperative control computed tomography the first postoperative day showed a small epidural bleed in the compartment that previously was filled with air, but the majority of the epidural air was removed and the midline was normalized (d)