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A case of traumatic pneumocephalus
The Journal of Emergency Medicine, Vol. 17, No. 6, pp. 1047–1048, 1999 Copyright © 1999 Elsevier Science Inc. Printed in the USA. All rights reserved 0736-4679/99 $–see front matter
PII S0736-4679(99)00138-9
Visual Diagnosis in Emergency Medicine A CASE OF TRAUMATIC PNEUMOCEPHALUS Brian Clyne, MD and Tiffany Medlin Osborn, MD Division of Emergency Medicine, Department of Surgery, University of Maryland Medical System, Baltimore, Maryland Reprint Address: Brian Clyne, MD, University of Maryland Medical System, 22 South Greene Street, Baltimore, MD 21201
A 39-year-old male presented to the Emergency Department (ED) with a chief complaint of headache for 3 days. The patient had fallen down a flight of stairs 3 days prior to presentation and had a loss of consciousness. Following the event, he noted clear nasal discharge and a salty taste in the back of his throat that had resolved spontaneously after 24 h. He finally sought medical attention for worsening headaches, intermittent dizziness, and right eye pain. On physical examination, he had a right periorbital contusion without step-off or crepitus. The eye was normal. The patient had no neck stiffness or meningeal
Figure 2. Arrow points to right orbital roof fracture.
signs. There were no neurologic deficits. There was no rhinorrhea or otorrhea. A noncontrast head computed tomography (CT) scan revealed bifrontal subdural and intraventricular pneumocephalus (Figure 1). Bone windows and coronal orbital views revealed a right orbital roof fracture communicating with the frontal sinus (Figures 2 and 3). There was no evidence of intracranial blood or shift. The patient was admitted for analgesia and serial neurologic examinations. He was also placed on intrave-
Figure 1. Large arrows point to frontal subdural pneumocephalus. Small arrow points to intraventricular air.
RECEIVED: 7 October 1998; FINAL ACCEPTED: 21 January 1999
SUBMISSION RECEIVED:
21 December 1999; 1047
1048
Figure 3. Arrow points to orbital roof fracture adjacent to right frontal sinus.
nous antibiotics. During his hospital stay, he had no neurological compromise and no evidence of cerebrospinal fluid leak. On hospital Day 2, a repeat head CT scan revealed decreasing bifrontal pneumocephalus. With his headaches controlled by NSAIDs, the patient was discharged on hospital day 3 and was asymptomatic at 1 month follow-up.
B. Clyne and T. Medlin Osborn
PII S0736-4679(99)00138-9
Visual Diagnosis in Emergency Medicine A CASE OF TRAUMATIC PNEUMOCEPHALUS Brian Clyne, MD and Tiffany Medlin Osborn, MD Division of Emergency Medicine, Department of Surgery, University of Maryland Medical System, Baltimore, Maryland Reprint Address: Brian Clyne, MD, University of Maryland Medical System, 22 South Greene Street, Baltimore, MD 21201
A 39-year-old male presented to the Emergency Department (ED) with a chief complaint of headache for 3 days. The patient had fallen down a flight of stairs 3 days prior to presentation and had a loss of consciousness. Following the event, he noted clear nasal discharge and a salty taste in the back of his throat that had resolved spontaneously after 24 h. He finally sought medical attention for worsening headaches, intermittent dizziness, and right eye pain. On physical examination, he had a right periorbital contusion without step-off or crepitus. The eye was normal. The patient had no neck stiffness or meningeal
Figure 2. Arrow points to right orbital roof fracture.
signs. There were no neurologic deficits. There was no rhinorrhea or otorrhea. A noncontrast head computed tomography (CT) scan revealed bifrontal subdural and intraventricular pneumocephalus (Figure 1). Bone windows and coronal orbital views revealed a right orbital roof fracture communicating with the frontal sinus (Figures 2 and 3). There was no evidence of intracranial blood or shift. The patient was admitted for analgesia and serial neurologic examinations. He was also placed on intrave-
Figure 1. Large arrows point to frontal subdural pneumocephalus. Small arrow points to intraventricular air.
RECEIVED: 7 October 1998; FINAL ACCEPTED: 21 January 1999
SUBMISSION RECEIVED:
21 December 1999; 1047
1048
Figure 3. Arrow points to orbital roof fracture adjacent to right frontal sinus.
nous antibiotics. During his hospital stay, he had no neurological compromise and no evidence of cerebrospinal fluid leak. On hospital Day 2, a repeat head CT scan revealed decreasing bifrontal pneumocephalus. With his headaches controlled by NSAIDs, the patient was discharged on hospital day 3 and was asymptomatic at 1 month follow-up.
B. Clyne and T. Medlin Osborn