Post-traumatic delayed intracerebral tension pneumatocele: A case report and review of literature

Abstract Aim Delayed intracerebral tension pneumatocele is an uncommon cause of raised intracranial pressure (ICP) following trauma. However it can cause herniation syndrome due to sudden increase in ICP which requires emergent intervention. The present case reports a late onset intracerebral tension pneumatocele in an adult male. Subject A 35-year-old man was admitted to our emergency unit with alleged h/o head injury following a road traffic accident. The computerised tomographic (CT) scan of head showed left frontal sinus fracture, basi frontal contusion and minimal pneumocephalus. Conservative treatment was given and patient discharged on 10th day in normal neurological state. After almost a month he was re-admitted with h/o of repeated vomiting and altered sensorium. A repeat CT head at this time revealed a large left frontal intracerebral tension pneumatocele with mass effect. The patient was operated on urgently and the tense air was evacuated. Dural graft covered over the tear behind the left frontal sinus. During the postoperative period the patient's neurological status improved. Result Although traumatic pneumatocele generally develops during the early post-traumatic period, it can also develop to a tension pneumatocele resulting in mass effect in the late period leading to increased ICP and deterioration of conscious level.