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CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0045-1811535
Case Report

Postoperative Tension Pneumocephalus with Mt. Fuji Sign: A Case Report

Majid Anwer 
1   Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Patna, Bihar, India
,
Rachith Sridhar 
1   Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Patna, Bihar, India
,
Anil Kumar
1   Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Patna, Bihar, India
,
Anurag Kumar
1   Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Patna, Bihar, India
,
Abhishek Kumar
1   Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Patna, Bihar, India
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Abstract

Tension pneumocephalus (TP) is an uncommon but potentially lethal complication of the neurosurgical process. The treatment is usually surgical decompression. We describe here a case of TP following evacuation of subdural hematoma (SDH) and its successful nonoperative management. A 75-year-old elderly male presented to the emergency department with a history of progressive weakness of bilateral upper and lower limbs and altered sensorium for 2 months. His Glasgow Coma Scale was E3V4M6, and pupils were bilaterally equal and reactive to light. A noncontrast computed tomography (NCCT) of the head showed bilateral acute-on-chronic SDH with internal septations and mass effect. The patient was planned and taken for bilateral craniotomy with membranectomy with evacuation of SDH. A repeat NCCT head showed development of bilateral TP with a “Mount Fuji” sign. The patient was placed on high-flow oxygen support and positioned with head-end elevation. Subsequent computed tomography scan showed resolution of intracranial air foci and expansion of the brain. Traumatic pneumocephalus is a dreaded complication of post-neurosurgical procedure. A high index of suspicion based on the clinical and radiological findings helps in identifying TP. Nonoperative management with closed observation is a viable option in clinically silent TP.

Keywords

head injury - Mount Fuji sign - neurosurgical procedure - subdural hematoma - tension pneumocephalus


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Artikel online veröffentlicht:
29. August 2025

© 2025. 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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