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CC BY 4.0 · Indian Journal of Neurotrauma 2023; 20(01): 045-048
DOI: 10.1055/s-0041-1739482
Case Report

Trauma-Associated Tension Pneumocephalus with Characteristic Mount Fuji Sign—Case Report

Utkarsh Khandelwal
1   Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
,
Anuj Ajayababu 
1   Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
,
Tej Prakash Sinha
1   Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
,
Sanjeev Bhoi
1   Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Tension pneumocephalus is a rare and life-threatening neurosurgical emergency in the setting of blunt or penetrating head trauma, especially in those with craniofacial fractures, which emergency physicians should be aware about. Early identification and appropriate treatment measures including supine positioning, 100% oxygen via mask, early neurosurgery consultation and, if required, operative intervention are paramount to optimal neurological and survival outcome. Definitive diagnosis requires imaging usually in the form of computed tomography (CT) head and serial monitoring of neurological status, optic nerve sheath diameter measurement and repeat imaging, essential to identify patients who might have features of increased pressure on brain matter, which could lead to adverse neurological and clinical outcomes. We present two cases of tension pneumocephalus with the characteristic Mount Fuji sign on CT head, who were managed nonoperatively with optimal neurological outcome. In patients with severe head or maxillofacial trauma presenting to emergency department, CT should be evaluated for signs of tension pneumocephalus, and such patients need to be closely observed for complications of pressure effect on brain matter to ensure optimal neurological and survival outcomes.

Keywords

case report - head trauma - mount fuji sign - raised intracranial pressure - tension pneumocephalus

Authors' Contributions

U.K. and A.A. were involved in patient management. U.K. and T.P.S. did the interpretation of clinical images. A.A. wrote the first draft of the manuscript, and T.P.S. and S.B. reviewed and edited the final version. All authors take full responsibility of the manuscript.




Publication History

Article published online:
13 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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