• Users Online: 548
  • Print this page
  • Email this page


 
 
Table of Contents
CASE REPORT
Year : 2021  |  Volume : 18  |  Issue : 3  |  Page : 215-216

Spontaneous extensive pneumocephalus with rare frontoethmoidal recess skull base defect presenting with acute headache


1 Department of Neurology, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India
2 Department of Neurosurgery, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India
3 Department of Radiology, Apollo Speciality Hospital, Nellore, Andhra Pradesh, India

Date of Submission27-May-2021
Date of Decision16-Jul-2021
Date of Acceptance20-Jul-2021
Date of Web Publication18-Aug-2021

Correspondence Address:
Manisha Sharma
Department of Neurology, Apollo Speciality Hospital, Pinakini Nagar, Nellore - 524 004, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_47_21

Rights and Permissions
  Abstract 


We report a 40-year-old diabetic female with acute headache and case of skull base defect causing pneumocephalus. The highlights of the present case are acute clinical presentation, extensive radiological findings, and rare skull base defect in frontoethmoidal recess.

Keywords: Cerebrospinal fluid rhinorrhea, pneumocephalus, skull base defect


How to cite this article:
Sharma M, Menon B, Anand V K, Sandeep Y, Manam G. Spontaneous extensive pneumocephalus with rare frontoethmoidal recess skull base defect presenting with acute headache. Apollo Med 2021;18:215-6

How to cite this URL:
Sharma M, Menon B, Anand V K, Sandeep Y, Manam G. Spontaneous extensive pneumocephalus with rare frontoethmoidal recess skull base defect presenting with acute headache. Apollo Med [serial online] 2021 [cited 2021 Dec 6];18:215-6. Available from: https://www.apollomedicine.org/text.asp?2021/18/3/215/324062




  Case Report Top


A 40-year-old diabetic female presented in the neurology outpatient department with a 1-day history of disabling holocranial headache. There was no history of head trauma, surgery, and air travel. Neurological examination was unremarkable. Magnetic resonance imaging brain [Figure 1] and [Figure 2] showed moderate subarachnoid and subdural pneumocephalus in bilateral cerebral sulci, fissures, and basal cisterns with mass effect on surrounding brain parenchyma. There was a bony defect in the left frontoethmoidal recess and cribriform plate region with cerebrospinal fluid (CSF) signal intensity in the left nasal cavity suggestive of CSF rhinorrhea. On direct questioning, she revealed a history of watery discharge from the nose for the last 4 years at a frequency of once in 4–5 months suggestive of CSF rhinorrhea which she assumed as sinusitis. Headache remained refractory on high-flow oxygen (5 L/min) for 3 days. Bifrontal craniotomy with anterior cranial fossa base repair was done under general anesthesia. The patient had postoperative symptomatic and radiologic recovery [Figure 3].
Figure 1: Magnetic resonance imaging brain showing pneumocephalus as abnormal hypointense signals in bilateral sulci (a and b), fissures, and basal cisterns (c)

Click here to view
Figure 2: Magnetic resonance imaging brain T2 coronal image showing an osseous defect (a and b; arrows) in the left frontoethmoidal recess and cribriform plate

Click here to view
Figure 3: Preoperative computed tomography brain showing pneumocephalus as bilateral subdural areas of hypoattenuation with compression on bilateral frontal lobes (a; arrowheads) with subsequent resolution in postoperative scan (b)

Click here to view



  Discussion Top


Pneumocephalus is defined as air in the intracranial space which may be epidural, subdural, or subarachnoid space, within the brain parenchyma or ventricular cavities.[1] Neurotrauma (fractures of the skull base or air sinuses, penetrating head injuries with dural lacerations) is the most common etiology of pneumocephalus followed by infections (meningitis or ventriculitis by gas-forming organisms), neoplastic, congenital skull base defects, iatrogenic (postsurgical), spontaneous (with spontaneous CSF rhinorrhea), and barotrauma.[2] The three locations of nontraumatic skull base defects with spontaneous CSF rhinorrhea described are ethmoid (53.6%), lateral sphenoid (28.6%), and midline sphenoid (17.9%).[3] In the present case, CSF leak and symptomatic pneumocephalus refractory to high-flow oxygen therapy were two independent indications for repair of radiologically proven skull base defect. Early diagnosis and management of pneumocephalus prevented possible complications such as meningitis, brain abscess, seizures, or development of tension pneumocephalus which causes neurological deterioration.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Álvarez-Holzapfel MJ, Aibar Durán JÁ, Brió Sanagustin S, de Quintana-Schmidt C. Diffuse pneumocephalus after lumbar stab wound. An Pediatr (Engl Ed) 2019;90:63-4.  Back to cited text no. 1
    
2.
Dabdoub CB, Salas G, Silveira Edo N, Dabdoub CF. Review of the management of pneumocephalus. Surg Neurol Int 2015;6:155.  Back to cited text no. 2
    
3.
Schuknecht B, Simmen D, Briner HR, Holzmann D. Nontraumatic skull base defects with spontaneous CSF rhinorrhea and arachnoid herniation: Imaging findings and correlation with endoscopic sinus surgery in 27 patients. AJNR Am J Neuroradiol 2008;29:542-9.  Back to cited text no. 3
    
4.
Das JM, Bajaj J. Pneumocephalus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535412/. [Last updated on 2020 Oct 13].  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed340    
    Printed13    
    Emailed0    
    PDF Downloaded21    
    Comments [Add]    

Recommend this journal