Tension pneumocephalus from orbital roof fracture.

Despite the detection and treatment of an extensive orbitocranial fracture in an 18-year-old man following a motor vehicle injury, the persistent leakage of CSF and trapping of air within the intracranial cavity resulted in fulminant neurologic deterioration due to the mass effect of air when tension pneumocephalus developed. The ethmoidal defect closed spontaneously, and the patient recovered neurologically when the tension pneumocephalus was relieved with a ventriculoatrial shunt. Orbitocranial injuries, which may be unsuspected despite careful orbital, neurologic, and conventional roentgenographic examination, have a considerable mortality. The presence of intracranial penetration. The CT scans, which detect as little as 0.5 mL of intracranial air, can be used to document serial changes in amount or position of air and detect shifts of the brain. tension pneumocephalus following orbitocranial injury and management with ventriculoatrial shunting have not been previously reported.