Tension pneumocephalus - A rare complication of cerebrospinal fluid leak

Three months following a craniectomy and cranioplasty indicated for intraperenchymal hemorrhage, a 74-year-old male suffered a cerebrospinal fluid leak complicated by delayed tension pneumocephalus and declining neurologic status demonstrating a particularly rare complication of neurologic trauma and surgery. While with symptoms of a space occupying mass is the most common presentation, the patient presented cerebrospinal fluid leak prompting CT imaging and diagnosis. Urgent surgical decompression is necessary and was performed resulting in improved mental status.