Aim: Delayed intracerebral tension pneumatocele (DITP) is an uncommon cause of raised
intracranial pressure following trauma. However, it can cause herniation syndrome
due to a sudden increase in intracranial pressure which requires emergent intervention.
Pneumocephalus is a complication of head injury in 3.9%–9.7% of the cases. The accumulation
of intracranial air can be acute (<72 h) or delayed (≥72 h). Method: When intracranial
air causes intracranial hypertension and has a mass effect with neurological deterioration,
it is called tension pneumocephalus. In our case series, we demonstrated four cases
of DITP in adult patients from January 2012 to January 2017 in the Department of Neurosurgery
at R. N. T. Medical College and M. B. Hospital, Udaipur, Rajasthan. Result: During
this period, a total number of patients admitted of head injury are 1768 and hence,
the incidence of DITP in our series is 0.226% which is very less as compared to previous
literature. All patients are male; age ranging from 17 years to 55 years (mean age
was 31.75 years). All patients have a history of head injury, and mode of injury had
road traffic accidents. Glasgow Coma Score (GCS) at readmission were 12–13 (mean GCS
12.75). Duration of developed DITP 1 month to 2½ months (mean 1.375 months), all patients
had gone to surgical intervention, and outcome assessed using Glasgow outcome score.
All patients had a good outcome and average follow-up was 12.5 months. Conclusion: long term observation of patients with simple pneumocephalus following trauma is
beneficial as there is an expected risk of developing delayed tension pneumocephalus
which may manifest with raised intracranial pressure.
Key-words:
Cerebrospinal fluid rhinorrhea - intracerebral - pneumocephalus - tension pneumatocele
