Etiology of Intracranial Pneumocephalus: A Retrospective Comparative Study of Traumatic and Iatrogenic Causes in Emergency Patients

Aim: The aim of this study was to retrospectively investigate the traumatic and iatrogenic causes of intracranial pneumocephalus (ICnP) in patients presenting to the emergency department (ED). Additionally, the study sought to evaluate the role of venous air embolism during intravenous (IV) line placement in the development of ICnP. Material and Method: A total of 462 patients who presented to the ED of a tertiary healthcare center between 2018 and 2024 were retrospectively analyzed. Patients included in the study presented with complaints of head trauma or headache but did not have open cranial wounds, evident basal skull fractures, or a history of intracranial surgery. Non-contrast cranial Computed Tomography (CT) scans were performed on all patients, and the anatomical localization of pneumocephalus as well as the IV line placement status were meticulously recorded. Statistical analyses were conducted using SPSS version 26.0, with a significance level of p0.05). However, a strong association was noted between IV line placement and venous air embolism. Conclusion: ICnP is commonly associated with venous air embolism occurring during IV line placement and resolves spontaneously within 24 hours in most cases. Our findings indicate that such air bubbles are typically attributed to iatrogenic causes rather than severe pathologies such as basal skull fractures. Avoiding unnecessary further investigations in patients whose air bubbles resolve within the first 24 hours can optimize clinical management and provide a cost-effective approach.