Teaching Neuro Images : Spontaneous tension pneumo-hydrocephalus may be related to otitis media and temporal bony defect

Abstract

Teaching NeuroImages: Spontaneous tension pneumo-hydrocephalus may be related to otitis media and temporal bony defect A 39-year-old woman with recurrent left otitis media presented with the sensation of fluid flowing in the head, headache, mild dyslexia, and disequilibrium for 2 weeks. She reported no head trauma and had a normal neurologic examination. Head CT (figure, A) showed intraventricular pneumocephalus and a focal low-density lesion with air-fluid level in the left posterior temporal region. Brain MRI showed minimal enhancement and no restriction of diffusion, and thus did not suggest an abscess (figure, B). CT of petrous pyramids demonstrated a small bone defect at the left posterior temporal bone, which was considered a possible point of entry for air (figure, C).1 CSF culture was negative. Lumbar puncture to release intracranial pressure and antibiotic therapy resulted in full recovery without surgical intervention. AUTHOR CONTRIBUTIONSDr. Yu: drafting/revising the manuscript, study concept and design, acquisition of data. Dr. Peng: drafting the manuscript, interpretation of data. Dr. Cheng: revising the manuscript, analysis of data. Dr. How: drafting/revising the manuscript, study supervision. STUDY FUNDINGNo targeted funding reported. DISCLOSUREThe authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

A rare presentation of headache and runny nose: A case of pneumocephalus

“…Other authors have used fluorescein, indigo carmine, CT myelography, radionuclide cisternography and MRI scan in order to find the cause of pneumocephalus [9]. With CT myelography appearing to be the gold standard for investigation [10,11].…”