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

Baba M, Tarar O, Syed A - Case Rep Neurol Med (2016)

Bottom Line: Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril.Conclusions.Idiopathic intracranial hypertension, although rare, can lead to CSF leak and pneumocepahlus.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.

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.

No MeSH data available.


Related in: MedlinePlus

Axial and coronal Computed Tomography images of the facial bones showing right sphenoid sinus bony defect and CSF collection.
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fig2: Axial and coronal Computed Tomography images of the facial bones showing right sphenoid sinus bony defect and CSF collection.

Mentions: Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril. Initial laboratory workup did not reveal any significant results. CT scan of the brain showed moderate amount of extra-axial air within the right cerebral hemisphere indicative of pneumocephalus as shown in Figure 1. CT scan of facial bones showed focal bony defect along thin roof of right sphenoid sinus with abnormal CSF collection immediately above and within the lateral recess of the right sphenoid sinus (Figure 2). Metastatic disease was ruled out with a negative bone scan and unremarkable CT scans of the chest, abdomen, and pelvis.


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

Baba M, Tarar O, Syed A - Case Rep Neurol Med (2016)

Axial and coronal Computed Tomography images of the facial bones showing right sphenoid sinus bony defect and CSF collection.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4863082&req=5

fig2: Axial and coronal Computed Tomography images of the facial bones showing right sphenoid sinus bony defect and CSF collection.
Mentions: Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril. Initial laboratory workup did not reveal any significant results. CT scan of the brain showed moderate amount of extra-axial air within the right cerebral hemisphere indicative of pneumocephalus as shown in Figure 1. CT scan of facial bones showed focal bony defect along thin roof of right sphenoid sinus with abnormal CSF collection immediately above and within the lateral recess of the right sphenoid sinus (Figure 2). Metastatic disease was ruled out with a negative bone scan and unremarkable CT scans of the chest, abdomen, and pelvis.

Bottom Line: Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril.Conclusions.Idiopathic intracranial hypertension, although rare, can lead to CSF leak and pneumocepahlus.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.

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.

No MeSH data available.


Related in: MedlinePlus