A 35-year-old man presented to the emergency department, with loss of consciousness subsequent to a fall off a wall of six-foot height. He struck his right occipital area against a short metal spike and was noted to have a small scalp laceration with a discharge of clear fluid consistent with cerebrospinal fluid (CSF). His Glasgow Coma Score (GCS) was 15 on admission. A plain film radiograph of his skull demonstrated pockets of air (figure 1) and an emergent CT scan demonstrated significant pneumocephaly (figure 2A, C, E, G) …
