Peaking sign (tension pneumocephalus)

The peaking sign is seen in cross-sectional imaging of the brain suggestive of a tension pneumocephalus. It represents the frontal lobes being pushed together forming a peak in the midline giving a heaped up appearance surrounded by air . Later, as the frontal lobes are separated they take on the so-called Mount Fuji sign.

Although usually encountered in the setting of tension pneumocephalus it is not pathognomonic of increased pressure.