Pneumocephalus with gas-fluid level

Case contributed by Dr Narek Matinyan

Presentation

Chronic headaches and dizziness.

Patient Data

Age: 70 years
Gender: Female

There is a collection of gas and fluid in the right hemisphere of the brain. The area of hypointense MR signal on T2 WI in the right frontal lobe is due to the presence of gas. The area of hyperintense MR signal on T2 WI in the right frontal and parietal lobes is due to fluid collection. There are no signs of surrounding oedema. 

There is a fracture of the ethmoid wall and the medial wall of the right orbit. 

The CT scan images were kindly contributed by Dr Kalina Kirakosyan.

Case Discussion

The patient was in a motor vehicle collision 15 years ago but did not attend hospital. During these years she did not undergo any imaging either. MRI examination showed a collection of gas and fluid in the right hemisphere, which is presumed to be a chronic process due to the absence of surrounding oedema. The CT scan showed a fracture of the right ethmoid wall and the medial wall of the right orbit, which is the likely entry site of the gas. 

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Case information

rID: 59028
Published: 23rd Mar 2018
Last edited: 23rd Mar 2018
Inclusion in quiz mode: Included

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