forceful nose blowing pneumocephalus triggered by compulsive Spontaneous intraparenchymal tension

The case is described of a 50-year-old man, treated for 10 years in an outpatient psychiatric clinicfor an obsessive compulsive disorder, who presented with acute loss of consciousness afterforceful nose blowing. A CT scan revealed an intraparenchymal air collection with tension signs inthe left frontal lobe and a bone defect in the roof of the ethmoid sinus. After emergency left frontalcraniotomy and dura opening, the gaseous collection was evacuated by a ventricular catheterinserted into the brain and the bone defect was repaired with pericranium flap and muscle. Thepostoperative course was uneventful with neurocognitive improvement and regained motility.Spontaneous tension pneumocephalus is a rare life-threatening condition which is often caused bya bone defect near the tegmen tympani. This case illustrates both an unusual cause and a uniquesurgical treatment for spontaneous tension intraparenchymal pneumocephalus. It can be adangerous entity with potential for early mortality and long-term morbidity if not promptlydecompressed. The pathogenesis, diagnosis and surgical strategies for spontaneous tensionpneumocephalus are briefly discussed.Spontaneous pneumocephalus is a rarecondition which represented only 0.6% inthe largest reported series of pneumo-cephalus.