Background: To report a case of fatal tension pneumocephalus in a 9-year-old boy following a severe motor vehicle accident.
Methods: A young boy with a serious closed head injury was resuscitated in the emergency room and underwent CT scan of the head and orbits.
Results: The CT-scan revealed a fracture of the orbital roof with extensive bilateral pneumocephalus.
Conclusions: A high index of suspicion for tension pneumocephalus is required in patients with severe head injuries presenting with periorbital swelling and perioccular trauma. A prompt CT scan and neurosurgical intervention are indicated.