Pneumocephalus in the absence of craniofacial skull base fracture.

We report a rare case of intracerebral pneumocephalus. It was not accompanied by the typical craniofacial skull base fracture. A 77-year-old woman presented with pneumocephalus following a pedestrian traffic accident. Neurologic and physical examination revealed multiple extensive emphysemas, multiple rib fractures, and lung contusions, but no facial or skull bone fractures. Computed tomography (CT) and simple X-ray did not reveal a craniofacial skull base fracture, although both imaging methods showed an air shadow in the internal carotid artery (ICA) pathway. Pneumocephalus and pneumoventricle are defined as an intracranial gas collection, with several reports in the literature describing various portals of entry and clinical situations that favor the introduction of air to the skull. Our report presents the possibility that pneumoventricle and pneumocephalus can occur even in the absence of a bony skull fracture.