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Prognosis, incidence and management of acute traumatic intracranial pneumocephalus

A retrospective analysis of 49 cases

Summary

CT scanning was carried out in 508 patients with acute head injuries. Retrospective analysis of the findings revealed intracranial air in 49 cases (9.7%). Air may be situated in the extradural, subdural or subarachnoid spaces or intracerebrally. A pneumocephalus was detected in 40 out of 49 (82%) of head injury patients within 6 hours of the accident. Injuries associated with a pneumatocele or a single intracranial air bubble have a good prognosis, as do frontobasal lesions. Injuries associated with multiple air bubbles have a bad prognosis. Intracranial air was a sign of a frontobasal or laterobasal fracture. In cases with a depressed skull fracture, extracerebral haematoma or pneumocephalus acting as a space occupying lesion, an operation should be performed as soon as possible. If associated with a persistent rhinorrhea the CSF-fistula should be operated according to the generally accepted rules13. In other post-traumatic cases intracranial air may be disregarded, although its presence may influence the choice of treatment.

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Steudel, W.I., Hacker, H. Prognosis, incidence and management of acute traumatic intracranial pneumocephalus. Acta neurochir 80, 93–99 (1986). https://doi.org/10.1007/BF01812281

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Keywords

  • Head injuries
  • pneumocephalus
  • cerebrospinal rhinorrhea and otorrhea