Non-surgical resolution of pneumocephalus following a sneeze

Abstract

Pneumocephalus is defined as the abnormal presence of air in the intracranial cavity. Pneumocephalus is most commonly caused by trauma, but there are rare reports of pneumocephalus secondary to allergy-induced sinusitis. In this report, we present a woman in her 60s who presented to the emergency department with a chief complaint of headache after experiencing a ‘popping’ sensation in her ears while sneezing. Over the course of a day, she began experiencing severe pain across the forehead along with copious amounts of clear rhinorrhea. A head CT without contrast was ordered, and findings revealed large amounts of intracranial air visualised diffusely throughout the subarachnoid spaces and the anterior horn of the left lateral ventricle. A diagnosis of pneumocephalus was confirmed. This patient made a full recovery without surgical intervention. Standard conservative therapy included bed rest, head elevation, avoidance of activities that increase intracranial pressure and antibiotic prophylaxis for meningitis.