Pneumocephalus Without Visible Fracture Preceding Subdural Empyema: A Delayed Emergency Department Diagnosis.
Asli Bahar Ucar, Nurseli Bayram
✦ AI-curated · Sources linked
Case in brief
A 16-year-old male presented to the emergency department after minor blunt frontal trauma. Initial cranial CT showed no fractures or acute pathology, leading to his discharge. He returned with scalp and periorbital swelling, and repeat CT revealed pneumocephalus and sinus opacification. Following a seizure and severe neurological decline, imaging confirmed subdural empyema, which was treated with burr-hole drainage. He recovered neurologically after antimicrobial therapy.
What made this case unusual
The presence of pneumocephalus without visible fracture in a patient with delayed presentation is noteworthy, as it can indicate serious underlying pathology.
Diagnostic / clinical pearl
Emergency physicians should recognize that pneumocephalus without visible fracture may signal significant intracranial complications and warrants further evaluation.
Why it matters
This case highlights the importance of thorough imaging review and consideration of repeat neuroimaging in patients with concerning symptoms following minor head trauma.