Intracranial air caused by barotrauma, malignancies, spinal anesthesia.
Most cases are secondary to a surgical defect, trauma, malignancy, or infection.
Trauma most common cause and accounts for up to 75% of cases.
Infections make up approximately 9% of cases, with most of these due to chronic otitis media.
Neoplasms make up about 13% of cases.
3.7% of cases are postoperative and 0.6% are idiopathic (spontaneous).
Implies a compromise in the craniodural barrier of the presence of gas, which forms an infection inside the cranial vault.
Trauma causes breach in the craniodural vault most commonly associated with fractures of the sinuses, skull base, cranial vault, or mastoid air cells.
2 cc of air is required for pneumocephalus to be visible on x-Rays, but as little as 0.5 ml can be detected with a CT scan.
Air can be seen in intraventricular, brain parenchymal, subarachnoid, or subdural space.
Intracranial air that produces a mass effect is known as tension pneumocephalus.
Presentation includes: nausea, vomiting, fever, headache, confusion, aphasia, vision alteration, seizures, paresis, hemiparesis, rhinos rhea and ataxia.
Majority of cases treated expectantly.
Treatment measures include: bed rest, analgesics, avoiding raising intracranial pressure by avoiding coughing, sneezing, nose blowing, and Valsalva maneuver’s, and preventing raised intra-abdominal pressure during bowel movements.
Supplemental oxygen enhances the absorption of
Tension pneumocephalus requires emergent neurosurgery.