A man in Northern Ireland had a highly uncommon cause for
his falls: He had a pocket of air inside his skull, called a pneumatocele.
Above, an MRI of the man's brain, showing the 3.5-inch (9 centimeters) air
pocket in his right frontal lobe.
Falls are a common problem among older adults, but for one
84-year-old man in Northern Ireland, a brain scan revealed a highly uncommon
cause for his falls: A part of his brain appeared to be missing.
The stunning scan revealed a large, black space behind his
forehead, where the front of his brain should have been.
His physician, Dr. Finlay Brown, a general practitioner in
Belfast, first reviewed the brain scan while waiting to hear back from
radiologists. (Typically, radiologists provide a report that accompanies a
scan, detailing what the image shows.)
"Immediately, I could see the abnormality and wondered
if the patient had failed to tell us about a previous brain surgery in his
younger years" or if the patient was born with a brain abnormality, Brown
told Live Science. When doctors were told that neither of these scenarios
applied to the patient, they were "left very curious as to the cause of
these findings," Brown said.
It turned out that the patient had a pocket of air inside
his skull, called a pneumatocele, which was compressing his brain tissue. These
air pockets are seen more commonly in patients who have facial trauma or
infections, or who have had brain surgery, according to a report of the case,
published Feb. 27 in the journal BMJ Case Reports.
Brown said he had never seen a case of brain pneumatocele
tied to symptoms of falling, and he decided to publish this case to emphasize
"the importance of thorough investigation of even the most common of
symptoms," Brown said. "Because every now and then, there will be a
rare [or] unknown causation of these that could be overlooked," he said.
Brown said he had never seen a case of brain pneumatocele
tied to symptoms of falling, and he decided to publish this case to emphasize
"the importance of thorough investigation of even the most common of
symptoms," Brown said. "Because every now and then, there will be a
rare [or] unknown causation of these that could be overlooked," he said.
When the patient first spoke with his doctors, he told them
told that, in addition to his frequent falls, he felt weakness in his left arm
and leg. But he was otherwise feeling well, and his initial physical exam was
normal.
But when the man was sent for a CT scan, the doctors
discovered the 3.5-inch (9 centimeters) air pocket in his right frontal lobe.
An MRI scan also revealed an osteoma, or benign bone tumor, in a part of the
skull that separates the brain from the nasal cavity, called the ethmoid bone.
The doctors determined that the osteoma wore away part of
the ethmoid bone, which allowed air to be pushed, under pressure, into his
brain, "creating a 'one-way valve' effect," the report said.
The MRI also revealed that the patient had experienced a
small stroke related to the air pocket in his brain.
Doctors told the man that they could perform brain surgery
to release the air from the cavity, which would allow his brain to resume its
normal shape, as well as a separate surgery to remove the osteoma.
But as with any surgery, there would be some risks for the
patient. For example, decompressing the brain area could have led to more
problems, and the surgery might not have helped the patient's symptoms, Brown
said.
Given the risks and potential benefits, the patient decided
not to have the surgery. He was treated with a statin and anti-clotting
medication to lower his risk of having another stroke, Brown said.
Twelve weeks after his hospital stay, the patient remained
well and no longer felt weakness on his left side, the report said.
https://www.livescience.com/61975-missing-brain-air-pocket.html
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Brown F, Vahidassr D. The man that lost (part of) his mind.
BMJ Case Rep. 2018 Feb 27;2018.
Abstract
An 84-year-old man presented to the emergency department
following recurrent falls over several weeks and onset of new left-sided
weakness. CT of the brain revealed a large air cavity (pneumatocoele) in the
right frontal lobe thought to be secondary to an ethmoidal osteoma
communicating through the cribriform plate allowing air to be forced into the
skull under pressure. Subsequent MRI confirmed these findings and also revealed
a small focal area of acute infarction in the adjacent corpus callosum. The
patient had a prolonged hospital stay, declined neurosurgical intervention and
was discharged home on secondary stroke prevention.
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