Health & the Human Body
Air on the Brain
By Cynthia Kirkeby
May 27, 2004, 10:21

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I found your site by accident. I am wondering if you can answer a question for me? My 18 year daughter died in a car accident. They said her neck was broken (c1) and when the x-ray was looked at by the doctor he said she had air in her brain so there would be no need for an autopsy. How does one get air in their brain from a broken neck?

First let us say that the staff at ClassBrain is terribly sorry for your loss. The death of a child is an almost unimaginable thing. We hope the research we’ve done will help answer your question.

“Air in the brain” is called pneumocephalus.
Pneumo = air
cephalus = head

It is an abnormal pocket of air in the brain that shows that there has been a breach of the skull vault. In other words air has entered the brain through the following barrier layers: the skin, scalp, skull, and dura.

From what we have been able to find, most of the time air in the brain is caused by a fracture to the face, specifically in the region of the sinuses. The breech can occur to the cribiform plate, the Maxillary sinus, or other structure in the head that allows the fluid in the brain to leak out and become replaced by air.

In your daughter’s case, it sounds as though the C1 fracture may have been displaced to the point that it ruptured the brain stem, and the CSF (cerebrospinal fluid) leaked out and allowed air to replace it.

The Following excerpt mentions air in the brain following head fractures and how it shows up in CT scans, which may be what the forensic surgeon was talking about in your daughter’s case. (See the final paragraph.)

If you have any additional questions, we would recommend that you speak to an emergency doctor, or your family doctor. They would probably be able to explain this further. We’re very sorry for your loss. We hope this helps answer your question.

The Following excerpt is from
The Congress of Surgeons
Medical Student Curriculum in Neurosurgery

A.2. Fundamentals of Neuro-Imaging

Skull fractures
The initial head CT scan can detect skull fractures in two thirds of all head injured patients (Macpherson). Fractures do not correlate with severity of head injury.

There are three types of skull fractures, linear, depressed, and diastatic. Linear fractures are nondisplaced and may be associated with epidural hematoma.

Depressed fractures are defined by displacement of the diploic tables of the skull in relation to one another. These are more often the result of impact with objects of smaller surface area, and are more often associated with parenchymal injury (Macpherson). Diastatic fractures are fractures along suture lines, and occur primarily in children. Skull fractures become problematic in children when there is associated tear of the dura and the patient develops an outpouching of brain tissue and meninges called a leptomeningeal cyst or growing skull fracture. Surgical repair is needed in this situation.

Fractures may be described as open or closed. An open fracture occurs when there is an overlying scalp laceration leading to potential communication between the intracranial space and the environment.

Fractures of the skull base may produce dural tears that communicate with paranasal sinuses or mastoid air cells. Clinically, these may be evident as a CSF leak from the nose (rhinorrhea) or ear (otorrhea). On CT, they may be recognized as pneumocephalus (air), which is characterized as very low-density (black) areas, near paranasal sinuses. Occasionally fractures may be visible on thin cut CT images through the skull base. Fractures through the temporal bone may disrupt the course of the facial nerve (CN VII) resulting in a complete ipsilateral facial paralysis.
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