Saturday, April 07, 2018 by Frances Bloomfield
An 84-year-old Northern Ireland man shocked his doctors with the results of his CT scan. In place of brain matter just behind his forehead, there was a large, dark space instead. That space turned out to be a 3.5-inch pneumatocele, or in layman’s terms, a pocket of air compressing the neighboring brain tissue.
According to LiveScience.com, this amazing discovery was the result of the man complaining to his doctors about his frequent falls. These are common among the elderly, though his case was unique in that those weren’t his only issues. Months of unsteadiness were compounded by three days of weakness in his left arm and leg. Apart from these, he was fine.
“There was no confusion, facial weakness, visual or speech disturbance, and he was feeling otherwise well,” his doctors wrote in their paper on the matter, published in BMJ Case Reports. “He was otherwise fit and well, independent with physical activities of daily living (PADLs) and lived at home with his wife and two sons. He was a non-smoker and drank alcohol rarely.”
A physical exam in the emergency room showed that he was slightly weaker in his left side, which may have been indicative of a stroke or brain tumor. Concerned, his doctors ordered a CT scan. It was then they discovered the pneumatocele and the possible cause: an osteoma in the ethmoid bone. Osteomas are benign head tumors made of bone; the ethmoid bone is a skull bone that separates the brain from the nasal cavity.
“An erosion by an osteoma (common benign bone tumor) through the cribriform plate (a honeycomb-like structure that’s part of the ethmoid bone) allowed air to gradually be pushed under pressure into the right frontal lobe causing resultant mass effect,” explained Drs. Finlay Brown and Djamil Vahidassr. Additionally, the man had a small stroke that Brown and Vahidassr believe was related to the air pocket.
Knowing all of that, they offered to surgically extricate the osteoma and remove the air pocket. “But as with any surgery, there would be some risks for the patient,” said Brown. “For example, decompressing the brain area could have led to more problems, and the surgery might not have helped the patient’s symptoms.” (Related: General anesthetic can cause serious brain damage following surgery.)
The patient declined to undergo surgery after he weighed the risks and benefits. In lieu of that, he was treated with anti-clotting medication and a statin. He felt better twelve weeks after his stay at the hospital, and no longer struggled with weakness at his left side.
In addition to benign skull tumors, surgery and head injuries can also contribute to the formation of pneumatoceles in the brain. These are actually how they usually come about. Speaking to Healthline.com, Dr. Nader Pouratian, a neurosurgeon affiliated with the David Geffen School of Medicine at the University of California Los Angeles (UCLA), elaborated: “Normally, there are three main things in the head: the brain, blood, and spinal fluid. During brain surgery, some spinal fluid rolls out.”
A pocket of air will then take the place of lost spinal fluid and blood. Although the brain is enclosed by the skull, air can still get in through small cracks or damaged areas. In the case of the patient, the ethmoid bone is especially thin, making it easier for fluids and air to flow in and out.
Thankfully remedying pneumatoceles aren’t all that difficult.
“The usual treatment is to get rid of the air and then seal the defect in the skull,” stated Pouratian.
Visit Brain.news to read up on more news stories or studies about the brain.