Disclosures: Alexander K. Wu, MD: Nothing to disclose

Case Description: A 20-year-old man who sustained a severe traumatic brain injury due to motor vehicle accident. The patient’s injuries included intracerebral hemorrhage, intraventricular hemorrhage, and multiple skull base fractures. He underwent emergent decompressive craniotomy and evacuation of hematoma. His rehabilitation stay was complicated by diabetes insipidus, panhypopituitarism, and retro-orbital pneumocephalus pocket on the skull base. ENT repaired a right ethmoid CSF leak endoscopically. CT head after surgery showed decreased pneumocephalus, however a repeat CT head 2 weeks later showed significant increase in gas encompassing approximately half of the frontal lobe. The patient’s family opted to have the patient flown home rather than pursue further treatment.

Setting: Academic freestanding rehabilitation hospital

Patient: Patient with severe traumatic brain injury and expanding pneumocephalus.

Assessment/Results: The patient was discharged via low altitude air ambulance, and safely made it back to his native country.

Discussion: The safety of flying patients with pneumocephalus has not been well documented in the literature. Boyle’s law states that for a fixed temperature, as air pressure decreases (as with increasing altitude), air volume will expand proportionally. When air pressure reaches a critical point, it can lead to brain herniation and death. In this case, the team opted to have patient flown back home via a low altitude flight to his home country to reduce the risk of brain herniation.

Conclusion: This is a unique case in which a patient with significant pneumocephalus was safely flown back home. The decision to fly back using a low altitude air ambulance was made in order to reduce the risk of brain herniation to the patient. This case may serve as an example to guide safety and logistics for future patients in which air travel is required for patients who have pneumocephalus.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pneumocephalus-and-successful-air-transport-home-a-case-report/