Management of pneumocephalus in a resource limited environment: Review from sub-Saharan Africa

Abstract

Background: Although pneumocephalus is not uncommon, most reports from Africa are of single or few cases.

Methods: A retrospective review of 20 patients with pneumocephalus managed in 4 years was done. There were 19 males and one female aged 22–45 years (median 35 years). The cause of pneumocephalus was head trauma in 18 patients and spontaneous in 2. The commonest symptoms were headache 19 and CSF rhinorrhoea 11. Skull radiographs and brain CT scan were used to confirm the diagnosis in all the patients. Eight patients had surgery while 12 were managed non-operatively.

Results: Of the eight that had surgery; six recovered fully, one had residual neurologic deficit and one died from meningitis. Ninepatients that were managed non-operatively recovered fully; one died also from meningitis and one refused treatment and left the hospital against advice.

Conclusions: Air in the cranial cavity behaves like any space-occupying lesion; a high index of suspicion is needed to make a diagnosis, prompt treatment and control of infection will prevent unwanted morbidity and mortality.

• Pneumocephalus
• aetiology
• CSF rhinorrhoea