Post-Traumatic Large Pneumoventricle With CSF Rhinorrhea: A Case Report

Pneumoencephalus results from the ingress of air into intracranial compartments due to a dural defect and is commonly encountered following head trauma or neurosurgical procedures. When air accumulates within the ventricular system, it is termed pneumoventricle, a rare entity that is usually self-limiting. However, progressive intraventricular air accumulation may lead to tension pneumoventricles, characterized by ventricular distension, mass effect, and features of raised intracranial pressure, necessitating urgent intervention. Post-traumatic large pneumoventricle is exceptionally uncommon, with only a few cases reported in the literature. A 23-year-old male who sustained a traumatic brain injury following a road traffic accident and initially presented with mild head injury was managed conservatively. He re-presented ten days later with generalized tonic-clonic seizure activity and cerebrospinal fluid rhinorrhea. Neuroimaging revealed pneumocephalus with large pneumoventricle. Despite radiological evidence of large ventricular air, the patient remained neurologically stable. A conservative management strategy comprising high-flow oxygen therapy, head elevation, avoidance of Valsalva maneuvers, carbonic anhydrase inhibition, and close neurological monitoring was instituted. Serial imaging demonstrated progressive resolution of intraventricular air, and the patient achieved complete clinical and radiological recovery without surgical intervention. This case highlights that, although large pneumoventricles are traditionally regarded as a neurosurgical emergency requiring ventricular decompression, selected neurologically stable patients may be successfully managed conservatively under strict monitoring. Early diagnosis, careful patient selection, and understanding of the underlying pathophysiology are crucial for optimal outcomes in this rare but potentially life-threatening condition.