Doctors find air pocket where part of man’s brain should be

By Amy B Wang | The Washington Post

The 84-year-old man arrived in the emergency room with complaints that weren’t uncommon for a patient his age.

He had reported feeling unsteady over the past several months, culminating in repeated falls in recent weeks. In the three days leading up to his hospital visit, his left arm and leg had noticeably weakened.

Still, there were no red flags in the man’s medical history. He didn’t smoke. He rarely drank. A blood test detected nothing abnormal.

“There was no confusion, facial weakness, visual or speech disturbance,” doctors stated in a summary of the man’s case published Feb. 27 in the medical journal BMJ Case Reports. “He was otherwise fit and well, independent with physical activities of daily living . . . and lived at home with his wife and two sons.”

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In other words, doctors thought, there was nothing apparent that would have suggested a clear reason for his symptoms. In a way, they wouldn’t be wrong.

It was only after CT and MRI scans that the patient’s medical team made an alarming discovery: Where much of the man’s right frontal lobe of his brain should have been, there was simply a large blank space.

Finlay Brown, a physician who was working in the emergency department at Causeway Hospital in Coleraine, Northern Ireland, at the time, remembers reviewing the brain-imaging scans with the rest of the staff.

“(We) were all very perplexed by the images we saw!” Brown told The Washington Post in an email.

The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. He said he had not.

It turned out the man had pneumocephalus, or the presence of air in his cranium, a condition that is found in “nearly 100 percent of cases after brain surgery,” Brown said. It can also occur after sinus infections and head or facial injuries – but with pockets of air or gas that are far smaller.

In this case, the patient’s pneumatocele – or pressurized air cavity – measured about 3 1/2 inches at its longest, according to the BMJ Case Reports article.

“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,” Brown told …read more

Source:: The Mercury News – Health

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