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Pneumocephalus. Secondary to chronic isolated sphenoid sinusitis. A case report

Salomon Waizel-Haiat, Armando Cruz-Hernandez.

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Introduction. Isolated sphenoid pathology is relatively rare. Within rinosinusitis patients, isolated sphenoid disease accounts for about 3% of cases. Meningitis is the main intracranial complication and it originates mainly in the sphenoid sinus. Pneumocephalus secondary to rinosinusitis is rare and is defined as a collection of intracranial air. Case report. We present the case of a 30-year-old male patient, who came to the emergency department for presenting bilateral parietal headache of 10 days of evolution, in computed tomography of the skull; sphenoid sinus occupation is appreciated as well as an air collection in the intracranial region, presenting an adequate response to medical treatment based on intravenous antibiotics and rest. Discussion. Pneumocephalus secondary to sphenoid sinusitis, with or without the presence of meningitis, is a rare entity. The signs and symptoms of pneumoencephalus can be very varied and range from subtle to severe and will generally depend on its location and extent. Being headache, the most common followed by rinorraquia or otorrhachia. The diagnosis is generally established radiographically, being computed tomography the study of choice. Conclusions. We present this case and a review of the literature to highlight the importance of identifying pneumocephalus as a sign of intracranial complication in the context of bacterial sinusitis. The presence of bone erosion or fungal infection is not necessary to produce pneumocephalus.

Key words: pneumocephalus, sinusitis, sphenoid sinus

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