| Summary: | Introduction: Occurrence of spontaneous pneumocephalus, without any determined cause like trauma, infection or surgery, is rare.
Case report: A 67-year old female patient was admitted to the outpatient clinic due to acute change in personality and occurrence of expressive aphasia. Imaging showed an intracranial pneumocephalus located in the left temporal lobe. High-resolution CT scan of the temporal bone demonstrated an osteo-dural defect of the floor of the middle cranial fossa. The defect was sealed with a duraplasty via a transmastoid approach following a quick postoperative recovery. Discharge was 10 days after surgery.
Six weeks later the patient presented with acute emesis, reported clear rhinorrhea and confusion. CT scan showed recurrence of the pneumocephalus on the left side. MRI scan demonstrated another defect in the left lateral temporal bone. A second surgery was performed in which a new osteo-dural leakage was found. The former duraplasty was unremarkable with no sign of liquorrhea. Another duraplasty was carried out. After operation the patient's clinical condition improved again rapidly. She was discharged on the 7th postoperative day. There has been no recurrence ever since.
Discussion: Etiology of these two consecutive osteo-dural defects remains unclear. An arachnoidal cyst as possible cause is under debate. However, a review of the radiological images could not confirm this theory.
Conclusion: Occurrence of spontaneous pneumocephalus is a rare event and should be considered in case of acute unspecific neurological symptoms. A diverse range of symptoms is described. Mostly surgical intervention is needed.
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