Tension Pneumocephalus-CT-Peaking Sign

Pneumocephalus can occur in iatrogenic and noniatrogenic disruption of the skull base or calvaria. It is important to differentiate tension from non tension pneumcephalus. A “peaking sign” of bilateral compression of the frontal lobes by subdural air collections without the characteristic separation of the frontal lobes has been linked to tension pneumocephalus as seen in the current case of post operative subdural hematoma. A more characteristic sign of tension pneumocephalus is Mount fuji sign in which bilateral subdural hypoattenuating collections cause compression and separation of the frontal lobes.