Spontaneous Tension Pneumocephalus Complicated by Secondary Meningitis: A Rare Case Report and Review of Literature
Hassan Mehdi1, Syed Mohsin Raza Bukhari1, Ghazi Abdullah1, Umema Shanza2, Areesha Zafar1, Amna Zaheer3, Muhammad Moiz Javed4, Muhammad Salman Sajid1, Syed Ijlal Ahmed5
1Nishtar Medical University and Hospital, Multan, 2Nishtar Hospital, Multan, 3Liaquat National Hospital and Medical College, 4Department of Neurology, Geisinger Wyoming Valley Medical Center, 5Department of Neurology, Saint Francis Medical Center
Objective:
To report a rare case of spontaneous tension pneumocephalus associated with secondary meningitis.
Background:
Spontaneous pneumocephalus is the abnormal presence of gas in the cranial cavity representing less than 1% of all pneumocephalus cases without any apparent cause, such as trauma, surgery, or an underlying medical condition, making it an exceptionally rare occurrence. It has an exceedingly rare association with meningitis. The clinical presentation often ranges from being asymptomatic to headaches, nausea, and dizziness and, in severe cases, can progress to tension pneumocephalus, which is a medical emergency, characterized by seizures, altered mental status, and focal neurological defects.
Results:
A 30-year-old female presented with headache, fever, recurrent seizures, and clear nasal discharge. The neurologic exam showed meningeal signs without focal deficits. There was no history of trauma, neurosurgical intervention, or recent sinus infections. CSF analysis revealed neutrophilic pleocytosis, low glucose level, and elevated protein consistent with bacterial meningitis. CT scan of the brain displayed extensive intracranial air collections with compression of the frontal lobe, referred to as the Mount Fuji sign, indicative of tension pneumocephalus. MRI brain revealed mild subdural loculated collections in the anterior interhemispheric fissure, mucosal thickening of the ethmoid and sphenoid sinuses, and hyper-pneumatization of bilateral frontal sinuses. The patient was managed conservatively with high-dose intravenous antibiotics. The likely source was a spontaneous skull base defect with secondary bacterial meningitis. MRI repeated after one month exhibited near-complete resolution of the pneumocephalus and associated inflammatory changes.
Conclusions:
Spontaneous pneumocephalus with secondary meningitis represents a rare but clinically significant entity that requires prompt recognition and appropriate management. This case underscores the value of early diagnosis and a multidisciplinary approach.
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