Intrathecal gadolinium-enhanced MR-cisternography for the detection of a petrous bone defect in a patient with spontaneous intraventricular pneumocephalus

  • Charlotte HarthEmail author
  • Ilse Peeters
  • Lieven Van Hoe
  • Gert Cypers
  • Sven Dekeyzer
Letter to the Editor


Spontaneous otogenic pneumocephalus is a rare entity. We describe the case of a 55-year-old patient with intraventricular pneumocephalus associated with a bony defect at the level of the right petrous bone caused by otomastoiditis. She presented herself at the emergency department with a 1-month history of progressive balance problems, tinnitus and fullness in the right ear. Head-CT showed pneumocephalus secondary to chronic otomastoiditis with focal erosion of the petrous bone. Nasal fluid analysis tested positive on the presence of beta-transferrin. MRI before and after intrathecal gadolinium administration showed leakage of gadolinium into the right mastoid air cells. The dural defect was closed by an artificial graft. Post-operatively, gait problems, rhinorrhea and tinnitus resolved, but of mild-to-moderate headache persisted at a 3-month outpatient evaluation. This article shows that CT is the imperative for the diagnosis of pneumocephalus and to detect the underlying cause. When there is doubt about the fistula location, MR-cisternography with gadolinium can be a valuable tool to detect or confirm the fistulous site.


Otogenic pneumocephalus Otomastoiditis Mr-cisternography 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Abbati SG, Torino RR (2012) Spontaneous intraparenchymal otogenic pneumocephalus: a case report and review of literature. Surg Neurol Int 3:32CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Arai N, Tabuse M, Nakamura A, Miyazaki H (2017) Spontaneous intraventricular pneumocephalus. J Craniofac Surg 28(3):738–740CrossRefGoogle Scholar
  3. 3.
    Soni JP, Choudhary S, Makwana M, Tripathi N (2016) Pneumocephalus in child following bilateral otomastoiditis and nasal septum infection. J Coll Physicians Surg Pak 26(7):626–628Google Scholar
  4. 4.
    Krayenbuhl N, Alkadhi H, Jung HH, Yonekawa Y (2005) Spontaneous otogenic intracerebral pneumocephalus: case report and review of the literature. Eur Arch Otorhinolaryngol 262(2):135–138CrossRefGoogle Scholar
  5. 5.
    Vallejo LA, Gil-Carcedo LM, Borrás JM, Campos JMD (1999) Spontaneous pneumocephalus of an otogenic origin. Otolaryngol Head Neck Surg 121(5):662–665CrossRefGoogle Scholar
  6. 6.
    Mohammed el R, Profant M (2011) Spontaneous otogenic pneumocephalus. Acta Oto Laryngol 131(6):670–674CrossRefGoogle Scholar
  7. 7.
    Abuabara A (2007) Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal 12:E397–E400Google Scholar
  8. 8.
    Hiremath SB, Gautam AA, Sasindran V, Therakathu J, Benjamin G. Cerebrospinal fluid rhinorrhea and otorrhea: a multimodality imaging approach. Diagn Interv Imaging. 2018;7Google Scholar
  9. 9.
    Wang EW, Vandergrift WA, Schlosser RJ (2011) Spontaneous CSF Leaks. Otolaryngol Clin North Am 44:845–856CrossRefGoogle Scholar
  10. 10.
    Hyam JA, Morgan L, Mendoza ND (2008) Coma caused by spontaneous otogenic pneumocephalus. Clin Neurol Neurosurg 110(1):62–64CrossRefGoogle Scholar
  11. 11.
    Stavas J, McGeachie RE, Turner DA, Nelson MJ (1987) Symptomatic intracranial pneumatocele from mastoid sinus of spontaneous origin. Case report. J Neurosurg 67(5):773–775CrossRefGoogle Scholar
  12. 12.
    Rabello FA, Massuda ET, Oliveira JA, Hyppolito MA (2013) Otogenic spontaneous pneumocephalus: case report. Braz J Otorhinolaryngol 79(5):643CrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  • Charlotte Harth
    • 1
    Email author
  • Ilse Peeters
    • 2
  • Lieven Van Hoe
    • 3
  • Gert Cypers
    • 3
  • Sven Dekeyzer
    • 4
  1. 1.MassemenBelgium
  2. 2.JetteBelgium
  3. 3.AalstBelgium
  4. 4.EdegemBelgium

Personalised recommendations