Traumatic tension pneumocephalus: Two case reports.
BACKGROUND
Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly.


METHODS
We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43- year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury.


CONCLUSIONS
These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Abubaker
A
Al-Aieb
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Ruben
R
Peralta
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Mohammad
M
Ellabib
Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. Electronic address: Aymanco65@yahoo.com.
Ayman
A
El-Menyar
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Hassan
H
Al-Thani
Cerebrospinal fluid leak; Head trauma; Rhinorrhea; Tension pneumocephalus