Pneumocephalus. A sign of intracranial involvement in orbital fracture
G. O. Waring 3rd and J. C. Flanagan
Fractures of the orbit resulting from blunt or penetrating injury that
involve the paranasal sinuses may tear the dura and allow air to enter the
cranial cavity (pneumocephalus). Pneumocephalus is sometimes the only sign
of intracranial involvement. It is characteristically delayed in onset and
clinically unsuspected, so that routine follow-up roentgenograms of
patients with orbitosinus fractures may be the only means of assuring early
detection. Roentgenographically, the air may be seen in spidural, subdural
subarachnoid, intracerebral, or intraventricular locations. Prophylactic
parenterally administered antibiotics may prevent intracranial infection.
However, since about 25% of patients still develop meningitis, surgical
repair of the dural fistula is often necessary.
