Tension pneumocephalus secondary to non-invasive mechanical ventilation in a patient with severe traumatic brain injury

The presence of air inside intracranial cavity is a rare entity known as pneumocephalus and in most cases doesnt present any clinical repercussion except in case of elevated intracranial pressure that can lead to a decreasing level of consciousness, coma and even death. We present a rare case of a young male, without medical precedents of interest, hospitalized in an intensive care unit for vigilance after a traffic accident with asymptomatic crane encephalic trauma and cranial computerized tomography without meaningful findings. During the intensive care unit stay positive pressure is applied in airway with non-invasive mechanical ventilation that produces air entrance in cranial cavity (pneumocephalus) causing neurological deterioration and necessity of urgent surgery. (C) 2017 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L.U. All rights reserved.