Intraventricular traumatic tension pneumocephalus: a case report.

Traumatic tension pneumocephalus with intraventricular extension is an extremely rare, potentially lethal condition that requires prompt diagnosis and treatment. A 27-year-old man was admitted with blunt head injury and rhinorrhea. There was no pathological finding on plain X-ray and axial computed tomography (CT) images. He had nothing remarkable but persistent nasal discharge. Biochemical and histological examination showed that the rhinorrhea material was cerebrospinal fluid (CSF). Lumbar spinal drainage was performed for the treatment of rhinorrhea. On the third day of drainage, he had headache, nausea and vomiting. A skull X-ray and CT scan revealed a large volume of intraventricular and subdural air in the frontotemporoparietal region, suggesting tension pneumocephalus. The CSF drainage was removed and medical treatment with mannitol (1 g/kg) was initiated, after which CSF rhinorrhea ceased and a gradual decrease in intracranial air volume was observed on follow-up CT scans. Improvement in his condition continued and the final CT scan demonstrated resolution of the pneumocephalus. The patient was discharged without any deficit.