Tension pneumocranium in childhood trauma

Background  To report a case of fatal tension pneumocephalus in a 9-year-old boy following a severe motor vehicle accident. Methods  A young boy with a serious closed head injury was resuscitated in the emergency room and underwent CT scan of the head and orbits. Results  The CT-scan revealed a fracture of the orbital roof with extensive bilateral pneumocephalus. Conclusions  A high index of suspicion for tension pneumocephalus is required in patients with severe head injuries presenting with periorbital swelling and perioccular trauma. A prompt CT scan and neurosurgical intervention are indicated.