Prognosis, incidence and management of acute traumatic intracranial pneumocephalus. A retrospective analysis of 49 cases.

CT scanning was carried out in 508 patients with acute head injuries. Retrospective analysis of the findings revealed intracranial air in 49 cases (9.7%). Air may be situated in the extradural, subdural or subarachnoid spaces or intracerebrally. A pneumocephalus was detected in 40 out of 49 (82%) of head injury patients within 6 hours of the accident. Injuries associated with a pneumatocele or a single intracranial air bubble have a good prognosis, as do frontobasal lesions. Injuries associated with multiple air bubbles have a bad prognosis. Intracranial air was a sign of a frontobasal or laterobasal fracture. In cases with a depressed skull fracture, extracerebral haematoma or pneumocephalus acting as a space occupying lesion, an operation should be performed as soon as possible. If associated with a persistent rhinorrhea the CSF-fistula should be operated according to the generally accepted rules. In other post-traumatic cases intracranial air may be disregarded, although its presence may influence the choice of treatment.