A Rare Case of Spontaneous Pneumocephalus Associated with Nontraumatic Cerebrospinal Fluid Leak

Murad Baba,Omer Tarar,Amer Syed

doi:10.1155/2016/1828461

Abstract

Introduction. Spontaneous nontraumatic pneumocephalus (PNC) and cerebrospinal fluid (CSF) leaks are both very uncommon conditions. We report a rare case of spontaneous pneumocephalus associated with CSF leak secondary to right sphenoid sinus bony defect without history of trauma. Case Description. 51-year-old Hispanic female with past medical history of hypertension and idiopathic intracranial hypertension (Pseudotumor Cerebri) presented to the emergency room complaining of headache and clear discharge from the right nostril. Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril. Computed Tomography (CT) scan of the brain showed moderate amount of extra-axial air within the right cerebral hemisphere indicative of pneumocephalus. CT scan of facial bones showed bony defect along the right sphenoid sinus with abnormal CSF collection. The patient was started on intravenous antibiotics for meningitis prophylaxis and subsequently underwent transsphenoidal repair of cerebrospinal fluid leak with abdominal fat graft. CSF rhinorrhea stopped completely after the surgery with near complete resolution of pneumocephalus before discharge. Conclusions. Early identification of pneumocephalus and surgical intervention can help decrease the morbidity and avoid possible complications. Idiopathic intracranial hypertension, although rare, can lead to CSF leak and pneumocepahlus.

Highlights

Spontaneous nontraumatic pneumocephalus (PNC) and cerebrospinal fluid (CSF) leaks are both very uncommon conditions
The main cause of PNC is head injury, trauma accounts for 74% of all cases followed by intracranial neoplasms, infections, neurosurgery, paranasal sinus surgery, and diagnostic or neurosurgical interventions such as pneumoencephalography or lumbar puncture [2, 3]
51-year-old Hispanic female with past medical history of hypertension and idiopathic intracranial hypertension (Pseudotumor Cerebri) presented to the emergency room complaining of headache for three weeks. Her headache was progressively worsening more on the right side, associated with clear discharge from right nostril which was aggravated by bending forward and straining

Summary

Introduction

Pneumocephalus (PNC) is defined as pathological collection of gas within the cranial cavity accumulating in the epidural, subdural, subarachnoid, intraventricular, or intraparenchymal compartments [1]. The main cause of PNC is head injury, trauma accounts for 74% of all cases followed by intracranial neoplasms, infections, neurosurgery, paranasal sinus surgery, and diagnostic or neurosurgical interventions such as pneumoencephalography or lumbar puncture [2, 3]. The developmental mechanism of pneumocephalus is mainly based on two factors: a reduction in intracranial pressure and the presence of a defect in the dura. It is caused by either a ball-valve mechanism that allows air to enter but not to exit or by CSF leakage which creates a negative pressure with subsequent air entry [2]

Case Description

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Discussion

Conclusion