Pneumocephalus in five horses.
Authors: Dunkel B, Corley K T T, Johnson A L, Witte T H, Leitch M, Marr C M, Weller R
Journal: Equine veterinary journal
Summary
# Editorial Summary: Pneumocephalus in Horses Pneumocephalus—the abnormal accumulation of gas within the cranial vault—remains poorly characterised in equine medicine despite its potential clinical significance. Dunkel and colleagues reviewed five cases from four referral institutions, identifying head trauma with sinus fractures as the primary cause (four cases), with one secondary to sinusitis or trauma. Radiography established diagnosis in four cases while computed tomography provided superior visualisation in the fifth, revealing gas distribution between the cranial vault and brain parenchyma, within the lateral ventricles, and extending into the cranial cervical canal. Although gas accumulation resolved gradually across all cases without directly causing neurological compromise at presentation, long-term follow-up proved sobering: of three horses with available outcome data, two required euthanasia due to secondary neurological deterioration. For practitioners managing head trauma or complicated sinusitis, this work underscores the importance of comprehensive skull and cranial cervical imaging; whilst pneumocephalus may initially appear incidental, the condition warrants careful monitoring as it retains potential for life-threatening progression, making computed tomography a valuable diagnostic tool for precise gas localisation and clinical decision-making.
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Practical Takeaways
- •Consider pneumocephalus as a potential complication following head trauma or sinusitis in horses; while often incidental, it can develop into a life-threatening condition requiring appropriate imaging and monitoring
- •Always image the complete skull and cranial cervical spine in horses with head trauma or sinus disease; CT imaging is superior to radiography for identifying and localizing intracranial gas
- •Understand that gradual resolution is typical; the presence of pneumocephalus alone does not necessarily indicate immediate neurological compromise, though other underlying injuries may determine prognosis
Key Findings
- •Five cases of pneumocephalus were identified, with head trauma and sinus fractures as the primary cause in 4 cases and sinusitis or trauma in 1 case
- •Gas accumulation resolved gradually in all horses and did not independently cause neurological compromise
- •Diagnosis was established radiographically in 4 cases and by CT in 1 case, with gas localized between cranial vault and brain, in lateral ventricles, brain parenchyma, and cranial cervical canal
- •Long-term outcome available for 3 cases, with 2 ultimately euthanized due to neurological deficits unrelated to pneumocephalus itself