Spontaneous Otogenic Pneumocephalus

Abstract

A very rare case of otogenic pneumocephalus in a healthy 24-year-old man with a widely pneumatized right mastoid, precipitated by forceful Valsalva's maneuver, is reported. When a pneumocephalus is suspected, computed tomography scans are mandatory. The pertinent literature is discussed and the potential mechanisms causing spontaneous pneumocephalus are described. To the best of our knowledge, only two other similar cases have been reported up to now.

Spontaneous Epidural Pneumocephalus -Case Report-

“…However, treatment of spontaneous pneumocephalus in general is managed surgically with the primary goals of decompression and prevention of infection via closure of the bone defect and fistula using autologous materials, such as cartilage, free fascia, temporal muscle flap, or bone powder combined with bone. 6,7,13,18,22) In addition, patient education can possibly contribute to reducing recurrence, as in our patient who was advised to give up his habit of frequent nose blowing.…”

“…9) Many cases of spontaneous pneumocephalus have been reported in the literature but only 9 cases were epidural in location (Table 1). 1,6,7,12,13,15,16,19) We describe a chronically symptomatic young patient with a giant spontaneous epidural pneumocephalus who was successfully treated by a single neurosurgical intervention.…”

Airhead with auras

“…The most plausible mechanism to explain that air may accumulate intracranially has been named the ball-valve. Air is propelled intracranially by forceful nose blowing, coughing, sneezing, straining or Valsalva's maneuver and once present is blocked by a tamponade effect [2]. We suppose that irritation of the occipital cortex due to the temporary increase of pressure in the hyperpneumatized occipital bone during Valsalva maneuvers may cause cortical spreading depression followed by a visual aura.…”

“…Approximately 15 cases of hyperpneumatized calvarial bones have been reported, several being related to Valsalva and Valsalvalike maneuvers [1]. A relation with visual auras has, to the best of our knowledge, been reported only once, notably a case of a 24-year-old man with an extradural pneumatocele who also performed Valsalva maneuvers [2]. Treatment approaches of hyperpneumatization of the calvarial bones range from a wait-and-scan policy or placement of an ear drum grommet in case of an extradural pneumocele to radical surgical treatment in case of subdural pneumocephalus [1,3].…”

A spontaneous Pneumocephalus and Hyperpneumatisation of occipital bone and atlas vertebra: a case report.

“…(1,4,8,10,12,15,16,18,20,22,26,28,29) Symptoms: The most common presenting symptom was severe headache. Other symptoms include aural fullness, otalgia, ear crepitations.…”