Last updated August 24, 2019 at 09:24 AM
An 84-year-old patient arrives at the emergency room with problems that are recurrent in people his age. He reported to his doctor that he felt unstable in the last few months and that he suffered from repeated falls. 3 days before his medical visit, his left arm and leg had weakened significantly.
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The patient in his medical file is a non-smoker, he rarely drinks and the blood test does not reveal any abnormality.
“There was no confusion, facial weakness, visual disturbance or speech,” the doctors said in a summary of the man's case published Feb. 27 in the medical journal BMJ Case Reports. “He was otherwise fit and healthy, independent with the physical activities of daily living… and lived at home with his wife and two sons.”
In short, the doctors simply found nothing abnormal after the required analyzes. They were about to declare that the patient had no physical medical problems when they did a final examination.
It was after the CT scan and MRI that they made an alarming discovery: where much of the human right frontal lobe should have been, there was simply a large empty space.
Credit: BMJ Case Reports
The causes
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“We were all very puzzled by the images we saw!” Finlay Brown told the Washington Post in an email. A doctor who worked in the emergency room at Causeway Hospital in Northern Ireland.
Brown estimates that the patient could have pneumocephalus or the presence of air in his skull which is found in "about 100% of cases after brain surgery".
“In my research for writing the case report, I couldn't find many documented cases of a similar nature to this,” Brown told The Post.
The cause of what appears to be pneumocephalus is revealed by MRI. it was an ostreoma or a kind of benign tumor of the bone found in the patient's skull. This tumor by its situation behaved by developing like a one-way valve bringing the air into the skull of its victim.
“Speaking to the specialists, it seems like she's progressed insidiously over the months to years,” Brown said. “When the patient sniffed, sneezed or coughed, she was probably sucking small amounts of air into her head.”
The case is fortunately treatable by operations allowing to treat the tumor on the one hand and to aspirate the captured air on the other hand. The patient refused both solutions because of his advanced age and various health problems. He is therefore sent home with treatments to prevent secondary stroke.
12 weeks later the patient reported that he no longer had weakness or falling problems and assured him that he was fine according to his case study.
Brown told LiveScience he wanted to publish this case study to underline "the importance of a thorough investigation of even the most common of symptoms," because the frequent falls and imbalances of an octogenarian could easily have been reversed. .
“Because every once in a while there will be rare [or] unknown causation of these that could be overlooked,” he told the science news site.
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