An 84-year-old man in Ireland in otherwise good health went to the emergency room with alarming symptoms - and doctors were stunned to find that he was missing the right frontal lobe of his brain. In the three days leading up to his hospital visit, his left arm and leg had noticeably weakened.
An 84-year-old man in Northern Ireland complaining of frequent falls and weakness on the left side of his body discovered that it was due to a massive air pocket that had filled the bulk of a section of his brain. Instead of brain tissue, the doctors found a 9 cm (~3.5 inch) pressurized pocket of air where much of his right frontal lobe ought to be.
Miraculously, a report published in the British Medical Journal Case Reports revealed he was suffering no confusion, facial weakness, visual or speech disturbance, and the man said that despite the stumbles he was feeling well. "He was a non-smoker and drank alcohol rarely".
According to Brown, the 84-year-old patient was in ideal health, with no history of smoking or drinking.
The air cavity had triggered a blood flow blockage to his corpus callosum, the part of the brain that connects the left to the right.
"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 said.
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Generally, pneumocephalus appear after brain surgery, sinus infections or head and facial injuries.
Dr Brown reported the air-pocket had actually been caused by a benign bone tumour in the man's sinus, which had eroded the base of his skull and created a "one-way valve" into his cranium, according to the BMJ Case Reports study.
Irish man had a 3.5-inch air pocket is his brain.
"We immediately realized there was something significantly abnormal about the images, even before our specialist radiology team had given us the formal report", said Dr. Finlay Brown, a general practitioner trainee in Belfast, who was one of the doctors on call at the hospital at the time, in an email. "When the patient sniffed/sneezed/coughed he would most likely be pushing small amounts of air into his head". Brown declared that his left-sided weakness was unrelated to the pneumocephalus but rather the side-effect of a minor brain stroke. However, due to the man's age and current state of health, he is declining surgery.
But the patient said he had suffered none. The patient was in otherwise ideal health, save for weakness on his left side and unsteady walking.
"We thought that this was a pocket of air but were not sure how it had got there!""Because every now and then, there will be a rare [or] unknown causation of these that could be overlooked", he said. For example, decompressing the brain area could have led to more problems, and the surgery might not have helped the patient's symptoms, Brown said.