Education  |   October 2017
Tension Pneumocephalus
Author Notes
  • From the Department of Anesthesiology, University of Connecticut, Farmington, Connecticut; and Hartford Hospital, Hartford, Connecticut.
  • Address correspondence to Dr. Palaniappan: palaniappan@uchc.edu
Article Information
Education / Images in Anesthesiology / Central and Peripheral Nervous Systems
Education   |   October 2017
Tension Pneumocephalus
Anesthesiology 10 2017, Vol.127, 710. doi:10.1097/ALN.0000000000001703
Anesthesiology 10 2017, Vol.127, 710. doi:10.1097/ALN.0000000000001703
BENIGN pneumocephalus commonly occurs in the early postoperative period after neurosurgery.1  Tension pneumocephalus, an uncommon but serious complication, occurs with entry of air through a dural defect and subsequent air expansion in the subdural, epidural, intraventricular, or intraparenchymal spaces due to a ball-valve mechanism.1,2 
Clinical presentations related to the mass effect include headache, deterioration in consciousness, seizures, focal neurologic deficits, Cushing response, and cardiac arrest. Computed tomography imaging reveals mass effect on the ventricular system and the classic “Mount Fuji” sign, with subdural free air compressing the frontal lobes and widening the interhemispheric fissure, simulating the silhouette of Mount Fuji.2  Correlation of the imaging features of tension pneumocephalus with signs of increased intracranial pressure allows for correct diagnosis of a neurosurgical emergency compared to the benign variety of postsurgical pneumocephalus.
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