Trauma is the most common cause of pneumocephalus as it accounts for approximately 70% of cases [
- Pillai P
- Sharma R
- et al.
Traumatic tension pneumocephalus – Two cases and comprehensive review of literature.
]. 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 [
The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional 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 [
Posttraumatic tension pneumocephalus.
]. In addition, when pneumocephalus is observed, the image should be reviewed for any signs of trauma.