Case ReportSpontaneous Intraventricular Tension Pneumocephalus: Case Report and Review of the Literature
Introduction
Pneumocephalus is a well-defined anomaly first was described in 1741 by Lecat. Spontaneous pneumocephalus (meaning in the absence of trauma, disease process, or iatrogenic intervention) was first described in 1954 by Jelsma and Moore.1 Markham2 further characterized spontaneous pneumocephalus in 1967, examining 295 cases of pneumocephalus and characterizing only 0.6% as spontaneous. Case reports of spontaneous otogenic pneumocephalus have been published.3, 4 Since 1967, there have been case reports describing spontaneous otogenic intraventricular pneumocephalus3 and describing spontaneous otogenic tension pneumocephalus,5 but to our knowledge, there has been only 1 previously reported case of a spontaneous otogenic intraventricular tension pneumocephalus.6 Tension pneumocephalus is a neurosurgical emergency that is caused by an accumulation of air resulting in increased intracranial pressures, which produces a myriad of clinical presentations, including restlessness, deteriorating consciousness, coma, and focal neurologic deficits.
Here we report a very rare case of patient who developed a spontaneous otogenic intraventricular tension pneumocephalus necessitating an emergent craniotomy for encephalocele repair and ventriculostomy.
Section snippets
Case Presentation
A 58-year-old African American female presented with a headache of 1 week's duration and voluminous rhinorrhea the day before presenting to the hospital. She reported no history of intracranial surgery, obstructive sleep apnea, trauma, infection, meningitis, scuba diving, or exceptional Valsalva maneuvers. A head computed tomography (CT) scan demonstrated extensive pneumocephalus with significant intraventricular involvement (Figure 1) and signs of mobile communication between the sphenoid
Discussion
Markham has described 2 theories regarding the pathophysiology of pneumocephalus.7 One theory is the ball-valve effect, which describes air being forced through the craniodural defect from coughing or nose blowing. The other theory is the inverted bottle effect, when there is dural defect with subsequent CSF leakage. CSF flowing out of the cranium results in a slight decrease in intracranial pressure, so air enters the cranium to equalize pressures. Spontaneous pneumocephalus is defined as an
Conclusions
Spontaneous otogenic pneumocephalus is a rarely described phenomena that usually results from a temporal bone defect. This defect permits air to communicate to the intracranial space. The presence of a dural defect allows air to communicate intradurally. Spontaneous intradural pneumocephalus is a rarely described entity that can be exacerbated by a ball-valve effect that can trap air, resulting in increased intracranial pressure. The treatment of choice for this is evacuation of the air,
References (16)
- et al.
Cranial aerocele
Am J Surg
(1954) - et al.
Coma caused by spontaneous otogenic pneumocephalus
Clin Neurol Neurosurg
(2008) - et al.
Spontaneous pneumatocele and pneumocephalus associated with mastoid hyperpneumatization
Eur J Radiol
(2000) The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases
Acta Neurochir
(1967)- et al.
Spontaneous otogenic pneumocephalus: case report and review of the literature
J Neurosurg
(1998) - et al.
Tension pneumocephalus related to spontaneous skull base dehiscence in a patient on BiPAP
Otol Neurotol
(2016) - et al.
Spontaneous intraparenchymal otogenic pneumocephalus: a case report and review of the literature
Surg Neurol Int
(2012) Pneumocephalus
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.