1. Spontaneous Tension Pneumocephalus Resulting From a Scalp Fistula in a Patient With a Remotely Placed Ventriculoperitoneal Shunt 
Jessica Monas, MD, David A. Peak, MD 
Annals of Emergency Medicine 
Volume 56, Issue 4, Pages (October 2010)
DOI: /j.annemergmed
Copyright © 2010 American College of Emergency Physicians Terms and Conditions

2. Figure 1
Remote burr holes in the scalp of a 59-year-old woman with a ventriculoperitoneal shunt and subsequent revision. The larger central lesion responsible for the tension pneumocephalus measures 2×3 cm and correlates to the craniotomy performed 5 years before presentation.
Annals of Emergency Medicine  , DOI: ( /j.annemergmed )
Copyright © 2010 American College of Emergency Physicians Terms and Conditions

3. Figure 2
Computed tomography of a patient presenting with right-sided hemiparesis demonstrates tension pneumocephalus with associated mass effect compressing the motor cortex. The pneumocephalus is in direct communication with a burr hole created 5 years earlier, which is acting as a 1-way valve.
Annals of Emergency Medicine  , DOI: ( /j.annemergmed )
Copyright © 2010 American College of Emergency Physicians Terms and Conditions

4. Figure 3
Magnetic resonance imaging of the brain 6 hours after emergency needle decompression shows resolution of the mass effect, with minimal residual pneumocephalus. This correlated with significant improvement in the patient's mental status and right-sided strength.
Annals of Emergency Medicine  , DOI: ( /j.annemergmed )
Copyright © 2010 American College of Emergency Physicians Terms and Conditions