Doctors find air pocket where part of man's brain should be
Doctors find air pocket where part of man's brain should be
The 84-year-old man arrived in the emergency room with complaints that weren't uncommon for a patient his age.
He had reported feeling unsteady over the past several months, culminating in repeated falls in recent weeks. In the three days leading up to his hospital visit, his left arm and leg had noticeably weakened.
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https://twitter.com/BMJCaseReports/status/969220420900737024
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The man that lost (part of) his mind - a man presented to the emergency department following recurrent falls over several weeks and onset of new left-sided weakness. Read the case background, treatment and follow up here >> http://ht.ly/ZkSR30iGX2s
10:38 AM - Mar 1, 2018
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Finlay Brown, a physician working in the emergency department at Causeway Hospital in Coleraine, Northern Ireland, at the time, remembers reviewing the brain-imaging scans with the rest of the staff.
"(We) were all very perplexed by the images we saw!" Brown told The Washington Post in an email.
The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. He said he had not.
It turned out the man had pneumocephalus, or the presence of air in his cranium, a condition that is found in "nearly 100 per cent of cases after brain surgery," Brown said.
It can also occur after sinus infections and head or facial injuries – but with pockets of air or gas that are far smaller.
In this case, the patient's pneumatocele – or pressurised air cavity – measured about 3.5 inches at its longest, according to the BMJ Case Reports article.
"In my research for writing the case report I wasn't able to find very many documented cases of a similar nature to this one," Brown said.
An MRI would show the pneumatocele's likely cause was an osteoma, or benign bone tumour, that had formed in the man's sinus and was eroding through the base of the skull, Brown said.
The tumor's formation and location had allowed for something of a "one-way valve effect" that had gradually contributed to the cranial air cavity, he added.
"From speaking to the specialists, it seems it has been progressing insidiously over months to years," Brown said. "When the patient sniffed/sneezed/coughed he would most likely be pushing small amounts of air into his head."
The air cavity was also reported as a "rare cause" of a small stroke the man had suffered, which had likely led to the left-side weakness and other symptoms that prompted the man's hospital visit, according to the BMJ Case Reports study.
Brown said the patient could have undergone surgeries: One that would decompress the air pocket in his head and another that would eliminate the tumour that had created the "one-way valve" and allowed air to move into the cavity in the first place.
However, the man declined both, because of his age and other health factors. He was given medication to prevent a secondary stroke and sent home with orders to monitor whether his left-side weakness worsened.
His nonsurgical approach is not without risk: It's likely the patient will be at a greater risk for infection, since there remains a passageway for air - and therefore bacteria and viruses - into his brain cavity, Brown said.
"Unfortunately, as there are not many cases published, it is hard to know the exact prognosis," Brown said.
So far, though, the man appears to be doing well, despite the cranial air pocket. During a follow-up appointment 12 weeks after his hospital visit, the patient reportedly no longer felt weakness on his left side and "remained well," according to his case study.
Brown told LiveScience he wanted to publish this case study to stress "the importance of thorough investigation of even the most common of symptoms," as an octogenarian's frequent falls and imbalance could have easily been written off.
"Because every now and then, there will be a rare [or] unknown causation of these that could be overlooked," he told the science news site.
The Washington Post
Doctors find air pocket where part of man's brain should be
The 84-year-old man arrived in the emergency room with complaints that weren't uncommon for a patient his age.
He had reported feeling unsteady over the past several months, culminating in repeated falls in recent weeks. In the three days leading up to his hospital visit, his left arm and leg had noticeably weakened.
View image on Twitter
https://twitter.com/BMJCaseReports/status/969220420900737024
BMJCaseReports@BMJCaseReportsThe man that lost (part of) his mind - a man presented to the emergency department following recurrent falls over several weeks and onset of new left-sided weakness. Read the case background, treatment and follow up here >> http://ht.ly/ZkSR30iGX2s
10:38 AM - Mar 1, 2018
Twitter Ads info and privacy
Finlay Brown, a physician working in the emergency department at Causeway Hospital in Coleraine, Northern Ireland, at the time, remembers reviewing the brain-imaging scans with the rest of the staff.
"(We) were all very perplexed by the images we saw!" Brown told The Washington Post in an email.
The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. He said he had not.
It turned out the man had pneumocephalus, or the presence of air in his cranium, a condition that is found in "nearly 100 per cent of cases after brain surgery," Brown said.
It can also occur after sinus infections and head or facial injuries – but with pockets of air or gas that are far smaller.
In this case, the patient's pneumatocele – or pressurised air cavity – measured about 3.5 inches at its longest, according to the BMJ Case Reports article.
"In my research for writing the case report I wasn't able to find very many documented cases of a similar nature to this one," Brown said.
An MRI would show the pneumatocele's likely cause was an osteoma, or benign bone tumour, that had formed in the man's sinus and was eroding through the base of the skull, Brown said.
The tumor's formation and location had allowed for something of a "one-way valve effect" that had gradually contributed to the cranial air cavity, he added.
"From speaking to the specialists, it seems it has been progressing insidiously over months to years," Brown said. "When the patient sniffed/sneezed/coughed he would most likely be pushing small amounts of air into his head."
The air cavity was also reported as a "rare cause" of a small stroke the man had suffered, which had likely led to the left-side weakness and other symptoms that prompted the man's hospital visit, according to the BMJ Case Reports study.
Brown said the patient could have undergone surgeries: One that would decompress the air pocket in his head and another that would eliminate the tumour that had created the "one-way valve" and allowed air to move into the cavity in the first place.
However, the man declined both, because of his age and other health factors. He was given medication to prevent a secondary stroke and sent home with orders to monitor whether his left-side weakness worsened.
His nonsurgical approach is not without risk: It's likely the patient will be at a greater risk for infection, since there remains a passageway for air - and therefore bacteria and viruses - into his brain cavity, Brown said.
"Unfortunately, as there are not many cases published, it is hard to know the exact prognosis," Brown said.
So far, though, the man appears to be doing well, despite the cranial air pocket. During a follow-up appointment 12 weeks after his hospital visit, the patient reportedly no longer felt weakness on his left side and "remained well," according to his case study.
Brown told LiveScience he wanted to publish this case study to stress "the importance of thorough investigation of even the most common of symptoms," as an octogenarian's frequent falls and imbalance could have easily been written off.
"Because every now and then, there will be a rare [or] unknown causation of these that could be overlooked," he told the science news site.
The Washington Post
