Spontaneous pneumocephalus after commercial air travel complicated by meningitis

Aviat Space Environ Med. 2011 Dec;82(12):1153-6. doi: 10.3357/asem.3100.2011.

Abstract

Background: Pneumocephalus usually results from trauma, infection, neoplasm, or iatrogenic causes. Barotrauma-induced spontaneous pneumocephalus is extremely rare, usually seen in divers or occassionally with air travel.

Case report: We report a case of a 61-yr-old female presenting with confusion, fever, and respiratory failure one day after developing sudden nausea, vomiting, and headache during descent on a commercial airliner. Pneumocephalus and meningitis were present on admission. Sinus computed tomography (CT) showed pansinusitis and a tiny bone defect in the posterior wall of the right sphenoid sinus, through which a cisternogram later showed free communication with the prepontine cistern. An orbital CT 2 yr earlier after a fall showed the bone defect, with no other areas of abnormality or fracture. After repair of defects by otolaryngology and appropriate antibiotics, she did well and was eventually discharged.

Discussion: Changes in aircraft cabin pressure likely resulted in rupture of dura and arachnoid layers beneath the pre-existing bony defect, predisposed by existing sinus disease. The pathophysiology, implications, and potential sources of spontaneous pneumocephalus, as well as risks of postcraniotomy and post-trauma air-travel, are discussed.

MeSH terms

  • Aerospace Medicine*
  • Barotrauma / complications*
  • Brain / pathology
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Meningitis / complications*
  • Middle Aged
  • Orbit / diagnostic imaging
  • Paranasal Sinuses / surgery
  • Pneumocephalus / etiology*
  • Pneumocephalus / physiopathology
  • Sphenoid Sinus / diagnostic imaging
  • Sphenoid Sinusitis / complications
  • Tomography, X-Ray Computed
  • Travel