Docs Find Skull Air Pocket in Man Who Kept Falling Over

Wednesday, 14 Mar, 2018

An 84-year-old man in Ireland had a pocket of air in his head where the right frontal lobe of his brain should have been.

. The man was a nonsmoker and drank rarely, the article continued.

Additionally, blood tests in the emergency department came back normal and he showed normal eye movement ranges, visual fields, speech, and swallowing.

He noted his left arm and leg had also become weaker but his apparent fitness and lack of "confusion or facial weakness" led doctors to believe there was nothing obvious, aside from age, to explain his symptoms. He was otherwise fit and well, independent with physical activities of daily living (PADLs) and lived at home with his wife and two sons. It was only when the doctors performed CT and MRI scans that they discovered the large, pressurized air mass in his brain, called a pneumatocoele.

The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. When doctors were told that neither of these scenarios applied to the patient, they were "left very curious as to the cause of these findings", Brown said.

Staff made a decision to give the man a CT and MRI scan, and it was then that they saw the blank where some of his brain should have been, measuring 3.5 inches long. The emergence of air in a brain cranium following a major surgery is also commonly attributed to this condition.

"In my research for writing the case report I wasn't able to find very many documented cases of a similar nature to this one", he added. Doctors found an osteoma, or benign bone tumor, in a part of the skull that separates the brain from the nasal cavity, called the ethmoid bone, the website said.

He said it had likely been forming over months, even years.

The MRI also revealed that the patient had experienced a small stroke related to the air pocket in his brain.

After consulting with specialists about surgery to release the air and remove the bone tumor, the man opted to skip any such intervention, given the risks.

His nonsurgical approach is not without risk: It's likely the patient will be at a greater risk for infection, since there remains a passageway for air - and therefore bacteria and viruses - into his brain cavity, Brown said.

At his twelve-week check-up he said the weakness in his left side had eased.

Brown said he had never seen a case of brain pneumatocele tied to symptoms of falling, and he chose to publish this case to emphasize "the importance of thorough investigation of even the most common of symptoms", Brown said.

"Because every now and then, there will be a rare [or] unknown causation of these that could be overlooked", he told LiveScience.

"The left-sided weakness was noted to have resolved on follow-up 12 weeks later and he remained well", the authors conclude in the published report.