title: Tension pneumocephalus with diplegia and deterioration of consciousness.
abstract: Tension pneumocephalus results from intracranial air under pressure as a rare complication after head injury or craniofacial surgery. A 58-year-old man underwent ethmoid sinus surgery and subsequently developed rapidly progressive global headache, restlessness, diplegia with sensory loss, and deterioration of the conscious level. A head CT demonstrated extensive pneumocephalus with gross compression of the brain. The frontal retention of air caused widening of the interhemispheric fissure leading to a peaked appearance of the frontal poles, referred to as the 'Mount Fuji sign'. Surgical revision of a dural air leak resulted in rapid improvement and full clinical resolution. Early diagnosis of tension pneumocephalus and emergent surgical treatment are crucial to prevent life-threatening deterioration.
authors.affiliation: Departments of Neurology, Charité-University Medicine Berlin, Campus Mitte, Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Prüss
authors.forename: Randolf
authors.initials: R
authors.lastname: Klingebiel
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres