Tension pneumocephalus and rhinorrhea related to chronic sinusitis

Pneumoencéfalo hipertensivo e rinorreia relacionados à sinusite crônica

A 42-year-old woman presented with a sudden-onset severe headache associated with vomiting and a persistent aqueous rhinorrhea. She had an allergic chronic sinusitis. There was no history of head trauma. Neurologic exam disclosed papilledema. The computed tomography (CT) scan showed opacification of the left sphenoid sinus and pneumocephalus extending from frontal region until convexity, compressing the supratentorial ventricular system (Fig 1). The cerebrospinal fluid (CSF) fistula was found in the left pterygoid process (Fig 2). Air probably came through the dural defect, and may have followed the CSF flow circuit. The physiopathology can be explained by bone defect, absence of nasal mucosa, and minor traumas¹,².

Fig 1.
Computed tomography shows huge pneumocephalus extending from right temporal fossa and bilateral frontal region until convexity compressing supratentorial ventricular system.

Fig 2.
High resolution computed tomography shows opacification of the left sphenoid sinus and bone defect of the left pterygoid process (arrow) permitting the airflow through the fistula.

References

• ¹
  Lefranc M, Peltier J, Demuynkc F, et al. Tension pneumocephalus and rhinorrhea revealing spontaneous cerebrospinal fluid fistula of the anterior cranial base. Neurochirurgie 2009;55:340-344.
• ²
  Webber-Jones JE. Tension pneumocephalus. J Neurosci Nurs 2005;37: 272-276.

Publication Dates

• Publication in this collection
  Apr 2013

History

• Received
  18 Mar 2012
• Received
  26 Nov 2012
• Accepted
  3 Dec 2012