A Case of Pneumocephalus

Abstract

The patient, D. P. M., aged 49, male, married, native American, by occupation a round-house hostler, was referred for X-ray examination by Dr. R. W. Mullen, of Sioux Falls, South Dakota, who supplied the history. The family and personal history was essentially negative. The patient had not been operated upon. On the afternoon of September 16, 1926, six days before the date of the roentgenologic examination, he was found standing in his engine cab with blood on his face. He was irrational, and on being removed from the engine had a convulsion which lasted two minutes. He was known to have been working in the fire-box and the probability is that he became overheated and fell, striking his head. He was removed to the hospital where he had another convulsion lasting two minutes. Physical examination showed a well developed and fairly well nourished man, restless and talking irrationally. The skin was of good color. There was a scalp wound, irregular in shape, 4 cm. in length, directly above the left eye. The examination was otherwise negative. The eye reflexes were normal. No paralysis or twitching of muscles. Pulse 90, temperature 98. Blood and urine negative. Patient remained irrational until September 19, when he regained consciousness; since that time he has continued to be rational. The convalescence was uneventful; the wound healed by first intention; temperature, pulse, blood and urine were normal, and the patient returned to work on October 15, feeling well. Roentgenologic examination was made on September 22, at which time a large pneumocephalus was noted on the left side, frontal area, apparently connecting with the frontal sinus. Re-examination was made two days later, when this air content was greater. Another examination was made at a subsequent time, when the air content was becoming less. Final roentgenograph was made November 9, showing complete absorption of the pneumocephalus. Roentgenologically, no definite evidence of fracture into the frontal sinus could be noted. X-ray diagnosis was pneumocephalus, left, presumably connecting with the frontal sinus through fracture.