영문제목 A case of pneumocephalus without craniofacial bone fracture

초록

To report rare case of intracerebral pneumocephalus without the craniofacial bone fracture. This report reviews a structural air pathway through the intracranium and a possibility that pneumoventricle and pneumocephalus can be occurred in a situation despite of no bony skull fracture.The 68 years female patient was experienced in pedestrian traffic accident. Consciousness was mild drowsy without neurologic deficits. She was suffered dyspnea due to hemopneumothorax. Severe subcutaneous emphysema was seen in her neck, face and chest. Battle's or Raccoon eye sign were not noted. No rhinorrhea or hemotympanium were present. A computed tomography(CT) scan of the head revealed a extensive pneumocephalus and pneumoventricle, mainly located in anterior horn of lateral ventricle and subarachnoid space. The images of the facial bones & skull base can not reveal a fracture. The air shadow was shown through the ICA pathway, pharynx and base of skull at neck area in initial Chest X-ray and facial bone CT. Closed thoracostomy and conservative management was done. Headache gradually resolved and a repeat head CT scan on hospital day 10 revealed almost complete resolution of pneumocephalus and pneumoventricle. The causes of pneumocephalus was has been reported in traumatic as well as non traumatic instances with communication between the intracranial vault and air containing cavity. The most common traumatic cause was craniofacial bone fracture with communication through an injury to the dura. But our patient did not have any evidence of CSF leakage and evidence of craniofacial bone fracture. We hypothesized that hemopneumothorax made in air for pneumocephalus, because of brief pressure gradient between intracranial & extracranial space through a subcutaneous tract of patient`s body through carotid artery, jugular vein and pharynx.