An Unusual Pattern of Skull Base Pneumatization.

Objective: Our aim is to describe an unusual pattern of craniocervical pneumatization resulting in a spontaneous fracture in a patient, who presented with tinnitus.

Methods: Temporal CT was ordered in a patient with tinnitus lasting over a year. His audiogram was normal. No history of previous trauma, recent flight, diving, or weight lifting was present. Further questioning revealed his habitual Valsalva maneuvers to relieve symptoms of nasal congestion.

Results: Temporal CT showed abnormal pneumatization of the occipital bone and C1 vertebra. A definite cortical defect resulted with the presence of air around the neighboring soft tissues. The emphysema was most prominent in the suboccipital fossa but it was also seen in the epidural space of the spinal canal.

Conclusion: Abnormal pneumatization of the skull base and cervical vertebra can be symptomatic due to its tendency to fracture. The presumed cause of pneumatization in this patient is habitual Valsalva maneuvers.