Docs Find Skull Air Pocket in Man Who Kept Falling Over

Modesto Morganelli
Marzo 14, 2018

An 84-year-old man in Northern Ireland complaining of frequent falls and weakness on the left side of his body discovered that it was due to a massive air pocket that had filled the bulk of a section of his brain.

Perhaps nothing too unusual for a man of his age, but further investigations revealed these symptoms were a red flag signaling much bigger problems. When the results from the CT scan came out, the doctors saw a 3-inch air pocket in his right frontal lobe.

Brown and co-author Djamil Vahidassr described the case in an article published in BMJ Case Reports in February. He was otherwise in pretty good health for his age - he didn't smoke or drink much, he was independent and he could still do physical activity.

The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. The condition is when a pocket of pressurized air forms within the cranium, which typically happens after brain surgery, the study's authors said.

"In my research for writing the case report I wasn't able to find very many documented cases of a similar nature to this one", Finlay Brown, a physician on the case, told the Washington Post.

The pneumocephalus, in this case, was caused by an osteoma, a benign bone tumor, that formed in the patient's sinuses and eroded through the base of his skull.

The tumour's formation and location had allowed for something of a "one-way valve effect" that had gradually contributed to the cranial air cavity, he added.

"From speaking to the specialists, it seems it has been progressing insidiously over months to years", Brown said. "When the patient sniffed/sneezed/coughed he would most likely be pushing small amounts of air into his head".

The air cavity was also reported as a "rare cause" of a small stroke the man had suffered, which had likely led to the left-side weakness and other symptoms that prompted the man's hospital visit, according to the BMJ Case Reports study. He was given medication to prevent a secondary stroke and sent home with orders to monitor whether his left-side weakness worsened.

"We thought that this was a pocket of air but were not sure how it had got there!"

As more air got in, it slowly pushed the brain aside, said Brown.

The patient declined surgery due to the risks it presented, and the case report stated, "the left-sided weakness was noted to have resolved on follow-up 12 weeks later and he remained well".

Brown and his coauthors, however, stressed in their paper that symptoms like this patient's should always be thoroughly explored.

"Because every now and then, there will be a rare [or] unknown causation of these that could be overlooked", he told the science news site.

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