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[page 24]                                                       [Emergency Care Journal 2016; 12:5726]

Using Mount Fuji for diagnosis
of tension pneumocephalus
Rohat Ak, Fatih Doğnay, 
Özge Ecmel Onur 
Department of Emergency Medicine,
Fatih Sultan Mehmet Education and
Research Hospital, Istanbul, Turkey

A 71-year-old-woman was admitted to our
emergency department because of headache,
vomiting and nausea. She had undergone
endoscopic sinus surgery the week before. On
examination, her Glasgow scale was 15/15 and
her vital signs were stable. An axial non-con-
trast head computed tomography (CT) demon-
strated a massive accumulation of air that was
compressing the frontal lobes which was called
Mount Fuji sign (Figure 1). She was operated
immediately and a control CT scan demon-
strated normal cerebral parenchyma (Figure
2). She was discharged from the hospital on
the fifth day without any neurological seque-
lae. Mount Fuji sign refers to the presence of
air between the tips of frontal lobes giving the
appearance of Mount Fuji and this sign is
indicative of a tension pneumocephalus. The
Mount Fuji sign on CT scan is useful in discri-
minating a tension from a non-tension pneu-
mocephalus. Tension pneumocephalus occurs
when the intracranial air causes a mass effect
and the brain is compressed. It has been repor-
ted to occur in a variety of situations, including
posterior fossa surgery in the sitting position,
use of an indwelling cerebrospinal drainage
device, trauma, otogenic infections, chronic
subdural hematoma drainage,1 and even spon-

taneously.2

Generally, the most common symptoms of
tension pneumocephalus are altered consci-
ousness, headache, generalized convulsions,
or restlessness,3 but even cardiac arrest cau-
sed by tension pneumocephalus.4

The discrimination of tension and non-ten-
sion pneumocephalus is crucial to prevent
serious conditions.

References

1. Paemeleıre K, Santens P, Boon P. Mount
Fuji sign following otogenic meningitis.
Acta Neurol Belg 2008;108:116.

2. Heckmann JG, Ganslandt O. The Mount
Fuji sign. New Engl J Med 2004;350:1881. 

3. Satapathy GC, Dash HH. Tension pneumo-
cephalus after neurosurgery in the supine
position. Brit J Anaesth 2000;84:115-7.

4. Thiagarajah S, Frost EA, Singh T, Shulman
K. Cardiac arrest associated with tension
pneumocephalus. Anesthesiology 1982;56:
73-5.

                             Emergency Care Journal 2016; volume 12:5726

Correspondence: Rohat Ak, Department of
Emergency Medicine, Fatih Sultan Mehmet
Education and Research Hospital, 34752 Istanbul,
Turkey. 
Tel: +90.216.5783000 - Fax: +90.216.5750406.
E-mail: rohatakmd@gmail.com

Key words: Tension pneumocephalus; Mount Fuji
sign; Emergency medicine.

Received for publication: 10 January 2016.
Accepted for publication: 18 January 2016.

This work is licensed under a Creative Commons
Attribution 4.0 License (by-nc 4.0).

©Copyright R. Ak et al., 2016
Licensee PAGEPress, Italy
Emergency Care Journal 2016; 12:5726
doi:10.4081/ecj.2016.5726

Figure 1. Axial computed tomography
scan demonstrating a massive accumula-
tion of air compressing the frontal lobes
(i.e., Mount Fuji sign).

Figure 2. A control computed tomography
scan demonstrating normal cerebral
parenchyma.

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