Intraparenchymal pneumocephalus with fluid level

Case contributed by Dr Heba Mohamed

Presentation

Trauma

Patient Data

Age: 25 years
Gender: Male

Multiple skull fractures of both temporal bones, left frontal bone, left orbital fracture as well as the anterior wall of the left frontal sinus. Multiple intraparenchymal gas pockets, the largest in the left frontal region and mostly connected to the left ethmoidal sinus, two smaller ones are demonstrated within the right frontal lobe as well as the midline.

One week follow up of the patient demonstrate resolution of the smaller midline vacuole, development of a gas-fluid level within the largest pocket seen at the left frontal region and complete filling of the right frontal pneumocephalus with fluid. The mass effect, contralateral midline shift and subfalcine herniation are stable in appearance. Abnormal medial deviation of the right globe suggests injury to the abducens nerve.

Case Discussion

A young male patient with a motorcycle accident resulted in multiple facial and skull fractures, two days after trauma the patient developed signs of increased intracranial pressure with an urgent CT scan done demonstrating the presence of multiple pneumocephalus pockets, mass effect, and shifting of the midline. One week MRI follow-up demonstrated the filling up of the gas vacuoles with fluid.

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Case information

rID: 59241
Published: 9th Apr 2018
Last edited: 9th Apr 2018
Inclusion in quiz mode: Included
Institution: Zagazig University Hospital

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