PMC7568131_01
(a-c) Computed tomography head without contrast when the patient was admitted for nausea, vomiting, and cerebrospinal fluid rhinorrhea showing pneumocephalus in the right and left cerebral hemispheres, basal cisterns, and lateral ventricles.
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F1
CT head without contrast was performed [Figure 1], which showed diffuse pneumocephalus.
(a) Computed tomography (CT) head preoperatively. (b) CT head postoperatively.
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F2
CT imaging preoperatively demonstrated large frontal pneumocephalus in the right cerebral hemisphere [Figure 2a] with significant decrease in size postcraniotomy and frontal sinus packing [Figure 2b].
(a and b) Computed tomography head with pneumocephalus causing oculomotor nerve palsy.
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F3
Repeat imaging showed persistent right pneumocephalus [Figure 3], which was treated with high-flow oxygen.
(a and b) Computed tomography head after improvement of pneumocephalus and subsequent improvement of palsy.
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F4
The patient then underwent placement of a right-sided epidural drain and external ventricular drain (EVD) with subsequent improvement in pupil size and reactivity over the next couple of days [Figure 4].
(a and b) Computed tomography head postoperative day 15 showing remaining pneumocephalus and resolving edema.
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F5
A follow-up CT scan was done on POD 15 revealing decreased amounts of pneumocephalus [Figure 5].