Case Presentation: We describe a delayed case of tension pneumocephalus in a newly altered patient 21 days status-post auto-vs-pedestrian accident. After her initial hospital course, the patient was discharged to an acute rehabilitation facility in stable condition with Glasgow Coma Scale 15. The patient returned to the emergency department for an acute change in mental status.

Discussion: Tension pneumocephalus is a neurosurgical and otolaryngological emergency.