A Rare Case of Spontaneous Pneumocephalus as a Complication of Nontraumatic Nasal Liquorrhea

Abstract

Pneumocephalus is the ingress of air into the intracranial cavity. Pneumocephalus is associated with several etiological factors, such as head injuries, surgical interventions, infections and neoplasms. With spontaneous nasal liquorrhea, pneumocephalus is extremely rare, since a defect must be large in order to cause it. Clinical implications of pneumocephalus depend on location and volume of air in the cranial cavity. The most common and described symptoms are headache, "splashing sound", rhinorrhea and otorrhea, meningism, dysfunction of cerebrospinal nerves, hemiparesis, optic disc edema, epileptic seizures, collaptoid states, psychiatric symptoms. For treatment of pneumocephalus, both conservative and surgical methods are used. The choice of tactics depends on type, etiology and volume of the air that has entered the cavity of the skull.In this article, we describe the case of effective treatment of spontaneous nasal liquorrhea, complicated by pneumocephalus and meningitis.

Spontaneous rhinorrhea: a possible concealing initial symptom of ecchordosis physaliphora. Illustrative case

“…The “inverted bottle effect” refers to the situation in which prolonged and profuse nasal liquorrhea in the cranial cavity creates negative pressure, resulting in air entering through an existing defect in an extracranial manner. 22 Compression of the cranial nerve VI as it travels through Dorello’s canal, 23 which may be narrowed by extrinsic compression of the tumor or a subarachnoid herniation, is a potential cause of diplopia. 24 The prepontine cistern is the most common location for an EP, with a frequency of 67%.…”