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An 84-year-old man with cognitive dysfunction was taken to the emergency room because of a change in consciousness. He came in with a Glasgow Coma Scale (GCS) score of E4V4M5. According to his family, this was not his usual state. It was difficult to hear the medical history from him, and there were few specific complaints. Upon physical examination, there were no abnormalities on the body surface and no complaints of pain. Head CT was performed to investigate the cause (Fig. 1 A and B).
Fig. 1A and B: Head computed tomography showing the air in the skull.
]. Upon reviewing the CT, a fracture on the left side of the head was detected (Fig. 1 C, D and E). After that, a head examination was performed again, and although no clear trauma was observed, tenderness was noted at the fracture site. The most common symptom of pneumocephalus is headache, but it has reportedly occured in only 38% of cases. Meanwhile, changes in mental status have occurred in 44% of cases [
]. Therefore, the testimony of people close to the patient is important. If the patient has dementia, it is often difficult to hear the patient's symptoms. In that case, it is important to ask the family if anything is different than usual. Head CT should not be hesitated if they say they are unusual. Although it is possible to diagnose pneumocephalus using plain images, CT examinations are more diagnostic. CT examinations can detect only 0.5 cm3 of air. In fact, the incidence of post-traumatic pneumocephalus is about 10 times higher on CT examinations than on plain images [
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