Highlights
- •Spontaneous otogenic pneumocephalus is a rare condition usually treated with surgery.
- •It can be managed conservatively with serial imaging follow up.
- •Hyperpneumatisation of the temporal bone with acute precipitating factor is commonly seen in cases of spontaneous otogenic pneumocephalus.
Abstract
Pneumocephalus is commonly seen on imaging in the setting of craniofacial trauma,
skull base tumours, intracranial infection and after neurological intervention. Spontaneous
pneumocephalus in the absence of these conditions is exceedingly rare, with only approximately
30 cases reported in the literature to date. Spontaneous otogenic pneumocephalus (SOP)
is believed to occur as a result of anomalous communication between the intracranial
space and a hyper-pneumatised temporal bone, with either positive extra-to-intracranial
pressure or negative intracranial pressure gradient. These anomalous communicating
channels may only become clinically apparent when triggered by episodes of acute increase
in middle ear pressure during coughing, sneezing, Valsalva manoeuvre or significant
change in atmospheric pressure. Patients may exhibit a wide range of neurological
symptoms and the aim of treatment is to reduce the risk of complications such as infection
and intracranial hypertension. Both conservative and neurosurgical approaches have
been described. We report a case of SOP in which the patient was conservatively managed,
and spontaneous resolution of pneumocephalus was documented on serial computed tomography
(CT) scans. This unique case clearly demonstrates the natural history and temporal
evolution of SOP without surgical intervention. This knowledge may potentially obviate
the need for surgery, thus reducing morbidity and mortality in patients who are poor
surgical candidates.
Keywords
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Article info
Publication history
Accepted:
February 18,
2021
Received:
December 9,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
