Traumatic cerebral venous air embolism associated with open skull fracture: Radiographic differentiation from pneumocephalus for clinical decision-making

Cerebral venous air embolism (CVAE) is a rare condition associated with various etiologies, including trauma. While intracranial air is a recognized finding in clinical practice, the pathway of its entry is rarely documented. An 84-year-old male presented following a head trauma after a fall. Computed tomography (CT) imaging revealed an open parietal skull fracture without associated intracranial hemorrhage. It also demonstrated that intracranial air was strictly restricted to the superior sagittal and cavernous sinuses. Consequently, a CVAE was diagnosed based on the air distribution, ruling out pneumocephalus. The patient remained clinically stable and was discharged after a 5-day hospital stay. Careful evaluation of the distribution of intracranial air on CT may aid in distinguishing CVAE from pneumocephalus and support appropriate clinical decision-making.