Clinical Neuroscience

[Traumatic prepontine tension pneumocephalus (in English language)]

KUNCZ Ádám1, ROOS Arne1, LUJBER László2, HAAS Daniella3, REFAI Al Mohamed4

OCTOBER 10, 2004

Clinical Neuroscience - 2004;57(09-10)

[Objective - A case of prepontine tension pneumocephalus after temporal bone fracture is presented. Case report - An 8-year-old girl suffered a head injury due to a fall off her bicycle. She lost her consciousness, and when she was admitted to the local hospital the Glasgow Coma Score (GCS) was 8/15 (eye opening: 2; verbal answer: 2; motor response: 4) and there was bleeding from the right ear. The patient's condition deteriorated rapidly and she needed intubation and ventilation. CT of the brain revealed large amount of air in the prepontine region, displacing the brainstem posteriorly. Patient was kept ventilated, meanwhile cerebrospinal fluid (CSF), as otorrhea appeared on the right side. CT was repeated 36 hours later, showing significantly less air in the prepontine area. The patient was weaned off the respirator, extubated and the level of consciusness improved. Later the patient developed meningitis, which was treated by systemic antibiotics with lumbar CSF drainage applied for five days. A high resolution CT scan of the petrous bone revealed a fracture crossing the middle part of the pyramid. Patient showed a full recovery except a right-sided mixed hearing loss. Conclusion - Rapid neurological deterioration following head injury can be a consequence of tension pneumocephalus. Prepontine pneumocephalus can be caused by minor fracture of petrous bone. High resolution CT is necessary to visualize minor fracture of the petrous bone. Conservative treatment may be satisfactory to treat tension hydrocephalus.]

AFFILIATIONS

  1. Division of Neurosurgery, Tawam Hospital, Al Ain
  2. Division of Ear-Nose-Throat Surgery, Tawam Hospital, Al Ain
  3. Division of Radiology, Tawam Hospital Al Ain
  4. Division of Neurosurgery, Al Ain Hospital, Al Ain, United Arab Emirates

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