Barotrauma-Induced Pneumocephalus Experienced by a High Risk Patient after Commercial Air Travel
A 49-year-old female presented to the emergency department with a severe headache, nausea, and vomiting after one hour flight on a domestic commercial airliner. Her mental status was alert without confusion. A cranial nerve examination revealed anosmia through both nostrils and a visual field defect of the left inferior homonymous quadranopsia. Additional cranial nerve function, motor and sensory function, the deep tendon reflex, and cerebellar function were normal.\nTen years ago, this patient was diagnosed with meningioma in the occipital lobe and underwent a suboccipital craniotomy to remove the tumor at another hospital. Further questioning revealed that the patient underwent four additional otolaryngologic operations (two operations involving the mastoid sinus and two involving the frontal skull base through the nose) to manage CSF rhinorrhea four years after initial the craniotomy. The patient did not know the precise cause of the CSF leak. Finally, a lumboperitoneal shunt was placed, and the patient did not experience further symptoms of a CSF leak. The revision surgery for a recurrent tumor was performed last year; at the time of the incident discussed here, the patient was returning home after gamma knife radiosurgery for the residual tumor.\nA computed tomography (CT) scan of the head () demonstrated extensive air within the subarachnoid space of the basal cistern, bilateral lateral and third ventricle, and extending to the intraparenchymal portion of the left frontal lobe.\nThe routine laboratory blood tests (leukocyte count, hemoglobin, hematocrit, glucose, blood urea nitrogen, creatinine, sodium, potassium, chloride, and C-reactive protein) were normal.\nNormal saline and analgesics were administered via an intravenous line, and a gradual resolution of the headache was achieved within several days. Seven days after presentation, the patient reported no complaints, and no evidence of meningoencephalitis was observed. The patient was warned not to fly before a definite diagnostic work up and sealing procedure for the CSF leak site was performed, and the patient was then discharged.