# Atraumatic Tension Pneumocephalus in a Shunted Patient: A Case of Rapid Neurological Decline

## TL;DR

This paper presents a case of a shunted patient who rapidly declined due to a rare condition called tension pneumocephalus, stressing the importance of early detection and treatment.

## Contribution

The paper adds to the clinical literature by highlighting the rare but severe complication of tension pneumocephalus in VP shunt patients.

## Key findings

- A 83-year-old VP shunt patient experienced acute neurological decline due to severe tension pneumocephalus.
- Despite surgical intervention, the patient developed a subdural hematoma and poor neurological recovery.
- The case underscores the need for prompt recognition and management of tension pneumocephalus in shunted patients.

## Abstract

Pneumocephalus is a rare but potentially life-threatening condition caused by the presence of air within the intracranial cavity. It commonly arises from trauma, neurosurgical procedures, infections, malignancies, or spontaneous causes. In patients with ventriculoperitoneal (VP) shunts, pneumocephalus may result from complications such as altered cerebrospinal fluid dynamics or skull base defects leading to a vacuum-like effect. We report a case of an 83-year-old male with a history of VP shunt placement for normal pressure hydrocephalus who presented with acute neurological deterioration, including aphasia and quadriparesis. Imaging revealed severe frontal pneumocephalus with mass effect and midline shift. The patient underwent emergent burr hole evacuation and VP shunt removal. Despite surgical intervention, he developed a new sizable subdural hematoma, leading to further deterioration. Following a prolonged critical course and poor neurological recovery, the patient was transitioned to hospice care. This case highlights the potential for severe tension pneumocephalus in patients with VP shunts, emphasizing the need for early recognition and prompt neurosurgical management. Given the high morbidity associated with tension pneumocephalus, clinicians should maintain vigilance for this rare but serious complication.