Shaikh N, Hussain G, Khan A, Khan MM, Al Mustafa M, et al. (2019) Tension Pneumocepha-lus Causing Cerebral Venous Sinus Thrombosis. Neurosurg Cases Rev 2:023.


© 2019 Shaikh N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and sreproduction in any medium, provided the original author and source are credited.

CASE REPORT | OPEN ACCESS DOI: 10.23937/2643-4474/1710023

Tension Pneumocephalus Causing Cerebral Venous Sinus Thrombosis

Nissar Shaikh1*#, Gulzar Hussain2, Adnan Khan3, Muhammad Mohsin Khan3, Mamdouh Al Mustafa4, Moad Ehfeda4, Muhammad Zubair2 and Umais Momin5

1Senior Consultant Surgical Intensive Care, Hamad Medical Corporation, Qatar

2Consultant Surgical Intensive Care, Hamad Medical Corporation, Qatar

3Department of Neurosurgical Sciences, Hamad Medical Corporation, Qatar

4Specialist, Department of Anesthesia/ICU& Perioperative Med. Hamad Medical Corporation, Qatar

5Department of Radiology, Hamad Medical Corporation, Qatar

#Equal contribution.



Pneumocephalus after craniotomy will absorb within four weeks, but when air causes pressure affects it is a tension pneumocephalus, which may affect consciousness and requires immediate intervention. Tension pneumocephalus causing cerebral sinus thrombosis is not known in the literature. We report a case of tension pneumocephalus causing diabetes insipidus associated with cerebral sinus thrombosis.

Case description

A 38-year-old Asian male had craniotomy with excision of a left frontal mass which extended into the lateral ventricles. External ventricular and subdural drains were inserted at the end of the procedure. He received mannitol and furosemide intraoperatively. Immediately after surgery he developed tension pneumocephalus, diabetes insipidus and fever. Two days after surgery, magnetic resonance imaging (MRI) showed transverse, sagittal sinus thrombosis extending into the right internal jugular vein. Pre-operative MRI and thrombophilia markers were unremarkable. Cerebrospinal fluid (CSF) analysis did not demonstrate leucocytosis and did not culture bacteria. Anticoagulation was initiated, but on the third day after surgery he developed severe brain swelling and became brain-dead.


In our patient tension pneumocephalus was complicated by diabetes insipidus and leading to cerebral sinus thrombosis after surgery.