Tension pneumocephalus
Updates to Article Attributes
Tension pneumocephalus is a neurosurgical emergency that occurs when subdural air causes a mass-effect over the underlying brain parenchyma, often from a ball-valve mechanism causing one-way entry of air into the subdural space 1.
Clinical featurespresentation
Tension pneumocephalus has a varied clinical presentation, with reported features including 2:
- severe restlessness
- deteriorating consciousness
- focal neurological deficits
- cardiac arrest.
Pathology
There are numerous aetiologies, including 1-3:
- trauma with leakage of cerebrospinal fluid
- recent neurosurgery (e.g. the complication risk is reported to be 2.5% after chronic subdural haematoma evacuation)
- tumours of the paranasal sinuses
- infections
- use of nitrous oxide as an anaesthetic agent (NO dissolves into blood and enters the subdural space, expanding the pre-existing gaseous volume)
Irrespective of the mechanism, the increased pressure leads to extra-axial mass effect and compression of the frontal lobes 1,2. The presence of air between the frontal tips suggests that the pressure of the air is at least greater than that of the surface tension of cerebrospinal fluid between the frontal lobes 4.
Radiographic features
Initially, subdural air compresses the frontal lobes resulting in the peaking sign is present, before the frontal lobes become separated in a characteristic appearance, aptly termed the Mount Fuji sign 3-5.
An additional reported sign of tension pneumocephalus is the presence of multiple small air bubbles in the subarachnoid space. This has been referred to as the air bubble sign6 .
These features are, however, not pathognomonic for tension pneumocephalus and can be seen in patients with normal intracranial pressures 7. Regardless of the exact pattern of intracranial gas, clinical deterioration is the key indicator for surgical intervention.
Treatment and prognosis
Tension pneumocephalus is a neurosurgical emergency 2. Treatment is with surgical decompression 2.
-<p><strong>Tension pneumocephalus</strong> is a neurosurgical emergency that occurs when subdural air causes a mass-effect over the underlying brain parenchyma, often from a ball-valve mechanism causing one-way entry of air into the subdural space <sup>1</sup>.</p><h4>Clinical features</h4><p>Tension pneumocephalus has a varied clinical presentation, with reported features including <sup>2</sup>:</p><ul>- +<p><strong>Tension pneumocephalus</strong> is a neurosurgical emergency that occurs when subdural air causes a mass-effect over the underlying brain parenchyma, often from a ball-valve mechanism causing one-way entry of air into the subdural space <sup>1</sup>.</p><h4>Clinical presentation</h4><p>Tension pneumocephalus has a varied clinical presentation, with reported features including <sup>2</sup>:</p><ul>
-</ul><p>Irrespective of the mechanism, the increased pressure leads to extra-axial mass effect and compression of the frontal lobes <sup>1,2</sup>. The presence of air between the frontal tips suggests that the pressure of the air is at least greater than that of the surface tension of cerebrospinal fluid between the frontal lobes <sup>4</sup>.</p><h4>Radiographic features</h4><p>Initially, subdural air compresses the frontal lobes resulting in the <a href="/articles/peaking-sign">peaking sign</a> is present, before the frontal lobes become separated in a characteristic appearance, aptly termed the <a href="/articles/mount-fuji-sign-1">Mount Fuji sign</a> <sup>3-5</sup>.</p><p>An additional reported sign of tension pneumocephalus is the presence of multiple small air bubbles in the subarachnoid space. This has been referred to as the <a href="/articles/air-bubble-sign-pneumocephalus">air bubble sign</a><sup>6</sup> . </p><p>These features are, however, not pathognomonic for tension pneumocephalus and can be seen in patients with normal intracranial pressures<sup> 7</sup>. Regardless of the exact pattern of intracranial gas, clinical deterioration is the key indicator for surgical intervention.</p><h4>Treatment and prognosis</h4><p>Tension pneumocephalus is a neurosurgical emergency <sup>2</sup>. Treatment is with surgical decompression <sup>2</sup>.</p>- +</ul><p>Irrespective of the mechanism, the increased pressure leads to extra-axial mass effect and compression of the frontal lobes <sup>1,2</sup>. The presence of air between the frontal tips suggests that the pressure of the air is at least greater than that of the surface tension of cerebrospinal fluid between the frontal lobes <sup>4</sup>.</p><h4>Radiographic features</h4><p>Initially, subdural air compresses the frontal lobes resulting in the <a href="/articles/peaking-sign-tension-pneumocephalus">peaking sign</a> is present, before the frontal lobes become separated in a characteristic appearance, aptly termed the <a href="/articles/mount-fuji-sign-1">Mount Fuji sign</a> <sup>3-5</sup>.</p><p>An additional reported sign of tension pneumocephalus is the presence of multiple small air bubbles in the subarachnoid space. This has been referred to as the <a href="/articles/air-bubble-sign-tension-pneumocephalus">air bubble sign</a> <sup>6</sup> . </p><p>These features are, however, not pathognomonic for tension pneumocephalus and can be seen in patients with normal intracranial pressures<sup> 7</sup>. Regardless of the exact pattern of intracranial gas, clinical deterioration is the key indicator for surgical intervention.</p><h4>Treatment and prognosis</h4><p>Tension pneumocephalus is a neurosurgical emergency <sup>2</sup>. Treatment is with surgical decompression <sup>2</sup>.</p>
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