An 88-year-old woman suffered recurrent falls. After one such fall, she presented with epistaxis, confusion, and progressive conscious decline. Her GCS was E4V3M5 and a CT showed a right-sided cribriform plate fracture (Fig. 1, top right) and severe pneumocephalus involving the extradural, subdural, intraventricular, and posterior fossa compartments (Fig. 1). Tension pneumocephalus was excluded as she slowly improved clinically (E4V4M6) and radiologically; the amount of intracranial air gradually reduced on high-flow oxygen. Pneumocephalus is common after neurosurgical and sinus procedures, but also after traumatic base of skull fractures. The Mount Fuji sign refers to tension pneumocephalus, when a ball-valve mechanism leads to air being trapped intracrani-ally, causing brain compression [1]. Pneumocephalus has also been reported after tamponade for epistaxis [2].
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