A very rare case of otogenic pneumocephalus in a healthy 24-year-old man with a widely pneumatized right mastoid, precipitated by forceful Valsalva's maneuver, is reported. When a pneumocephalus is suspected, computed tomography scans are mandatory. The pertinent literature is discussed and the potential mechanisms causing spontaneous pneumocephalus are described. To the best of our knowledge, only two other similar cases have been reported up to now.
MatsubaHMThawleySESmithPG. Tension pneumocephalus: A case following otologic surgery. Am J Otol1986; 7: 208–9.
5.
TakahashiKKamazawaHNarukawaYSatoY. Pneumocephalus associated with carcinoma of the maxillary sinus. J Oral Maxillofac Surg1992; 50: 405–8.
6.
KinsleySDoughertyY. Tension pneumocephalus related to an epidermoid tumor of ethmoid sinus origin. Ann Emerg Med1993; 22: 259–61.
7.
MylonasC. Delayed pneumocephalus in patients with CSF shunts. Br J Neurosurg1991; 5: 67–72.
8.
ClevensRABradfordCRWolfGT. Tension pneumocephalus after endoscopic sinus surgery. Ann Otol Rhinol Laryngol1994; 103: 235–7.
9.
Gonzalez-CarrascoFJAguilerJLLlubiaCNoguesSVidal-LopezF. Pneumocephalus after accidental dural puncture during epidural anesthesia. Reg Anesth1993; 18: 193–5.
10.
AshKMCannonJEBiehlDR. Pneumocephalus following attempted epidural anaesthesia. Can J Anaesth1991; 38: 772–4.
11.
ConettaRNiermanDM. Pneumocephalus following nasotracheal intubation. Ann Emerg Med1992; 21: 100–2.
12.
Nolla-SalasJBalaguer-MartinezECarrasco-GomezGLlovet-TapiesJ. Pneumocephalus, etiology, pathologic significance and diagnosis. Apropos of 13 observations. Neurologia1989; 4: 12–8.
13.
CanavanLOsbomRE. Dural sinus air without head trauma or surgery: CT demonstration. J Comput Assist Tomogr1991; 15: 526–7.
14.
StavasJMcGeachieRETurnerDANelsonMJ. Symptomatic intracranial pneumatocele from mastoid sinus of spontaneous origin. Case report. J Neurosurg1987; 67: 773–5.
15.
AhrenCThulinCA. Lethal intracranial complication following inflation in the external auditory canal in the treatment of serous otitis media, and due to defects in the petrous bone. Acta Otolaryngol (Stockh)1965; 60: 407–21.
16.
WolffDBelluciJREggstoneAA, eds. Microscopic anatomy of the temporal bone. Baltimore, Md: Williams and Wilkins, 1957.
17.
DietzelR. Investigations of the “normal” pneumatisation of the temporal bone. HNO1989; 37: 39–47.
18.
LundsfordLDMaroonJCSheptakPE. Subdural tension pneumocephalus. Report of two cases. J Neurosurg1979; 50: 525–7.
19.
HorowitzM. Intracranial pneumocele. An unusual complication following mastoid surgery. J Laryngol Otol1964; 78: 128–34.
20.
AzarkiaBSarwarMBatnitzkyS. Radiology of intracranial gas. Am J Roentgenol1975; 124: 315–23.
