Delayed Expanding Intracerebral Pneumatocele Following Severe Craniofacial Trauma: A Case Report With Serial Imaging Correlation

Pneumocephalus is a common complication of craniofacial trauma; however, delayed progressive enlargement resulting in intracerebral pneumatocele represents an uncommon and potentially life-threatening condition. We report a case of a 27-year-old male with severe traumatic brain injury following a road traffic accident with extensive skull base fractures. Initial imaging demonstrated hemorrhagic contusions with small intracranial air foci that resolved on early follow-up. Subsequently, delayed reappearance and progressive enlargement of air in the basifrontal region, manifesting as an intracerebral pneumatocele and likely related to persistent communication with the frontal sinus, resulted in significant mass effect with midline shift and subfalcine herniation. Surgical repair of the anterior cranial fossa defect was performed, resulting in clinical and radiological improvement. Delayed expanding intracerebral pneumatocele is a critical complication of skull base trauma. Serial imaging and close clinical monitoring are essential for early detection and timely management.