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Case Report
Pneumocephalus after a prolonged course of bacterial sinusitis: A case report
1 MD, Fellow, Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
2 MD, Resident, Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
3 MD, Assistant, Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
Address correspondence to:
Amanda Tieu-Mi Huynh
McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8,
Canada
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Article ID: 100054Z09AH2019
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Huynh ATM, Huynh JTU, Goodliffe L, Raghavan N. Pneumocephalus after a prolonged course of bacterial sinusitis: A case report. J Case Rep Images Med 2019;5:100054Z09AH2019.ABSTRACT
Introduction: Pneumocephalus, or air in the intracranial cavity, is an uncommon finding that suggests a breach in the meningeal layer. Sinusitis, on the other hand, is a common phenomenon caused by inflammation of the tissue lining, the nasal cavity, and paranasal sinuses secondary to bacterial or viral infections. Rare cases of spontaneous pneumocephalus, in the absence of trauma or surgery, have been reported in the literature. They may also occur with more common pathologies such as nose blowing, sneezing, and Valsalva maneuvers.
Case Report: Here, we report a case of spontaneous pneumocephalus associated with sinusitis in a 28-year-old man who presented to the hospital with a history of severe frontal headaches in the context of three weeks of sore throat, cough, and rhinorrhea. He was struggling with significant coughing and sneezing leading up to the hospital admission. A computed tomography (CT) scan of his head showed pansinusitis with extra-axial pneumocephalus measuring 5 mm over the anterior left frontal lobe that was worrisome for intracranial extension of sinusitis. Otolaryngology determined that either a stifled sneeze or a vigorous nose blowing may have introduced air intracranially. Repeat CT head showed resolution after treatment with antibiotics and conservative management.
Conclusion: In our literature search, we have found only seven other cases of pneumocephalus associated with sinusitis, and four cases of spontaneous pneumocephalus associated with either sneezing or nose blowing. Although sinusitis is an extremely common condition, red flags such as nonresolving symptoms, headache, or facial pain should prompt further work-up to consider alternative diagnoses or complications such as pneumocephalus.
Keywords: Pneumatocele, Pneumocephalus, Sinusitis, Sneeze
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Acknowledgments
We would like to thank Dr. Shauna Kennedy from the Department of Radiology for helping us interpret the CT head findings.
Author ContributionsAmanda Tieu-Mi Huynh - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Jessica Tieu-Uyen Huynh - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Laura Goodliffe - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Natya Raghavan - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Amanda Tieu-Mi Huynh et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
