The man had been referred to the emergency room by his family doctor in Northern Ireland.
"What worried me most in an elderly patient with a new limb weakness and balance disorders was some form of stroke," said Dr. Finlay Brown, lead author of the report and general practitioner in Belfast who treated the man.
Doctors performed brain scans to identify any signs of bleeding or brain damage caused by blocked blood vessels, according to Brown.
But what they found was much more unusual.
Small benign tumor
A computerized tomography of the patient's brain showed a large air pocket, also called pneumatocele. – in the patient's right frontal lobe that was approximately 3½ inches long.
"We knew immediately that there was something very abnormal," Brown said. "Initially, we thought that perhaps the patient had not revealed having previously had some form of operation or a congenital anomaly, but … confirmed that he did not."
The air pocket was just behind the frontal sinus and above the cribrous plate, which separates the nasal cavity from the cranial cavity.
When pneumatoceles are present in the brain, the condition is often referred to as pneumocephalus. Commonly, they compress the frontal lobe, which plays an important role in voluntary muscle movement, said Cohen.
An MRI of a man's brain also showed a small benign bone tumor, or osteoma, that had formed in man's paranasal sinuses and was eroding through the base of the skull, causing air to leak into the skull. cranial cavity, according to the report.
& # 39; Inverted Coca Cola Bottle & # 39;
"It's like a bottle of inverted Coca," Cohen said. "Sometimes, there may be a one-way valve, and the air comes in and can not come out."
The pressure of the air cavity may also have caused a Small stroke in the patient's frontal lobe, resulting in the weakness of the left side and the instability of the gait that caused his visit to the hospital, according to Brown.
"After discussing with the spill specialists, it was thought that his small stroke was probably secondary to the compressed effect that the air pocket had on the blood supply of his brain, which caused a lack of blood and stroke subsequent, "said Brown. .
Treatment for pneumocephalus depends on several factors, particularly the symptoms involved. Many cases of pneumocephalus have no symptoms and are eventually absorbed by the body without treatment, according to Cohen.
In more severe cases, such as those that cause high blood pressure in the brain or deterioration of consciousness, decompression surgery to relieve pressure on the brain may be necessary.
In this case, the patient received surgical treatment from a team of neurosurgeons and otolaryngology surgeons. The procedure would have involved the temporary surgical removal of a part of the frontal bone of the skull and the removal of the bone tumor to close the leak that was sending air to the brain.
However, due to his age and other health factors, the patient refused surgery and instead chose a conservative treatment that included medications to prevent an accident secondary cerebrovascular
"We managed the patient with his acute stroke and we kept him comfortable while we waited for the help of a specialist," Brown said.
When the patient returned for a 12-week follow-up visit, he felt better and no longer complained about the left lateral muscle weakness, according to the report.
"It is very unlikely that he will see the same findings in another patient," Brown added. "But it encourages doctors to have a low threshold for images even when they face very common presentation symptoms."
Due to the lack of studies to evaluate pneumocephaly, the exact prognosis for the patient remains unclear.
The case of this type is that, over time, we do not know if more air enters than the one that comes out, which would cause neurological instability, "said Cohen.
" You can live quite well with only a limited amount of cerebral cortex. Sometimes, it is reorganized, and nature is quite intelligent in terms of finding ways to heal. "