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May 1976

Cranial Pneumatocele—A Clue to the Diagnosis of Occult Epidural Abscess

Author Affiliations

Dept of Neurology Southwestern Med School Univ of Texas Health Science Center at Dallas Dallas, TX 75235

Arch Neurol. 1976;33(5):372-373. doi:10.1001/archneur.1976.00500050058014

The spontaneous appearance of air on skull roentgenograms, referred to as cranial pneumatocele or pneumocephalus, is uncommon. Most of the reported cases are related to head trauma, with communication between one of the sinuses or mastoids and the epidural or subdural space.1 We have recently observed a patient in whom the roentgenographic clue suggested the diagnosis of epidural abscess.

Report of a Case.—  A 15-year-old boy had a seven-day history of malaise, intermittent chills, nausea and vomiting, hallucinations, and bifrontal headaches. He had fallen nine days prior to admission, striking the midfrontal region of his head, without loss of consciousness or amnesia. On examination, his temperature was 39.8 C and he had a stiff neck. There was no external evidence of infection or cerebrospinal fluid (CSF) rhinorrhea. Results of neurological examination were normal. A lumbar puncture showed an opening pressure of 180 mm H2O, 22 white blood

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