|Year : 2021 | Volume
| Issue : 3 | Page : 215-216
Spontaneous extensive pneumocephalus with rare frontoethmoidal recess skull base defect presenting with acute headache
Manisha Sharma1, Bindu Menon1, VK Anand2, Yashwanth Sandeep2, Gayatri Manam3
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 Submission||27-May-2021|
|Date of Decision||16-Jul-2021|
|Date of Acceptance||20-Jul-2021|
|Date of Web Publication||18-Aug-2021|
Department of Neurology, Apollo Speciality Hospital, Pinakini Nagar, Nellore - 524 004, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
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|| |
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)|
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|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|
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|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)|
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| Discussion|| |
Pneumocephalus is defined as air in the intracranial space which may be epidural, subdural, or subarachnoid space, within the brain parenchyma or ventricular cavities. 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. 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%). 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.
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]