• Jiashan Chen, Shao-An Wang, Chun-Yen Huang, Yuan-Hui Wu, and Chien Chieh Hsieh.
• Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
• J Emerg Med. 2023 Dec 1; 65 (6): e517e521e517-e521.

BackgroundPneumocephalus is defined as gas in the intracranial space. Common causes include head trauma, surgery, and diagnostic/therapeutic procedures resulting from the direct disruption of the dura. Spontaneous or nontraumatic pneumocephalus is an uncommon condition, often caused by infection, either due to insidious disruption of the dura or gas-forming pathogens.Case ReportHerein, we report a rare case of spontaneous pneumocephalus associated with meningitis in a patient who received conservative treatment without surgical intervention. Blood culture revealed group A streptococcus. The pneumocephalus subsided gradually with antibiotic treatment, and no neurological deficits remained. A follow-up brain computed tomography scan showed the absence of pneumocephalus, but it showed progressive hydrocephalus. The patient was discharged on the 21st day of hospitalization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous pneumocephalus associated with meningitis is rare. It should always raise the suspicion of meningitis and prompt suitable treatment. Emergency physicians should always be vigilant for this particular possibility on brain computed tomography.Copyright © 2023 Elsevier Inc. All rights reserved.

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