Delayed post-traumatic Tension Hydropneumocephalus;a Case Report of Conservative Treatment

Pneumocephalus refers to the presence of air in the cranial cavity. Trauma is the most common cause of acquiredpneumocephalus. Tension pneumocephalus occurs when intracranial accumulation of air causes high pressureon the brain as compared to extracranial pressure. Tension pneumocephalus is usually acute, and causes neu-rological symptoms, and its delayed form rarely occurs. A 12-year-old girl presented with a headache, lethargy,mild fever, and nausea from two days before admission to emergency department of Shahid Rajaei Hospital,Qazvin, Iran. The patient had a history of head trauma in a driving accident six weeks before and had under-gone brain computed tomography (CT) scan in another centre, which had revealed no sign of pneumocephalus.The patient had been treated for one week and had been discharged in good general condition. Consideringher reduced consciousness, the patient underwent brain CT scan again in our centre. CT scan revealed tensionhydropneumocephalus. The patient was transferred to the intensive care unit (ICU) for treatment. Consideringthe trend of her recovery, the patient was a candidate for conservative non-surgical therapy based on the in-charge neurosurgery specialist’s decision. The patient reported no complications during the six-month follow-up. Delayed tension pneumocephalus is among neurosurgery emergencies usually treated with early surgicalintervention and dura defect restoration, but this patient received non-surgical treatment without any seriousproblem during the six-month follow-up.