• Ramin Javan, Richard Duszak, Alan D Eisenberg, and Frank M Eggers.
• Baptist Memorial Hospital, Department of Radiology, Memphis, TN, USA. ramin.javan@duke.edu
• Aviat Space Envir Md. 2011 Dec 1;82(12):1153-6.

BackgroundPneumocephalus 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 ReportWe 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.DiscussionChanges 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.

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