Spontaneous otogenic pneumocephalus due to altitude changes: A case report and review of literature.

Background And Importance: Pneumocephalus secondary to trauma, infection or a tumor is a rare entity. In the absence of an underlying cause, it is considered to be spontaneous and represents around 1% of cases of pneumocephalus.

Case Report: In the present article, we describe the case of a male patient who presented with altered level of consciousness following his transition to an increased altitude (1000 m). CT scan demonstrated air located in the subdural, intraventricular and intraparenchymal compartments. He was found to have spontaneous otogenic pneumocephalus with an osteo-dural defect at the upper level of the petrous temporal bone resulting from a change in atmospheric pressure brought on by a change in altitude. A right subtemporal craniotomy with a right temporal duraplasty was performed. The patient had no recurrence after three years of follow-up.

Conclusion: A fistula at the level of the temporal bone should be investigated in any patient with otologic manifestations and nonspecific neurological signs. This is the first case to describe a patient with spontaneous otogenic pneumocephalus with distribution of air in three intracranial locations. Surgery remains the treatment of choice for spontaneous otogenic pneumocephalus.