Doctors flabbergasted: an air pocket where part of his brain should have been

An 84-year-old man from Northern Ireland is a literal air head — and that’s no insult. He has a large air pocket where part of his brain should be.

When the man turned up in the emergency room, it looked like a routine case. He’d been feeling unsteady for several months and had suffered a series of falls in the previous few weeks. He finally decided to go to the hospital after three days of his left arm and leg becoming progressively weaker. These complaints would seem normal enough for someone of his age, but curiously, there weren’t any particular red flags in his medical history. As his doctors wrote in a journal article: “There was no confusion, facial weakness, visual or speech disturbance. He was otherwise fit and well, independent with physical activities of daily living… and lived at home with his wife and two sons.”

Since there was no obvious explanation for his symptoms, the doctors decided CT and MRI scans were in order. The images were astonishing: where the right frontal lobe of his brain should have been, there was nothing! Had the patient forgotten to tell them about previous surgery or a birth defect? Nope.

Eventually, the medical team figured out what was going on. He had “pneumocephalus,” that is, the presence of air in his skull! While a little bit of air can enter the skull as a result of brain surgery, they couldn’t find a case like this one anywhere in the medical literature. The cause turned out to be a benign bone tumor in the man’s sinus that had created a “one-way valve effect.” Whenever he sniffed, sneezed, or coughed, a tiny amount of air went into his skull. There were a couple of surgical options, but given the risks, the patient decided against going under the knife. Doing nothing also posed risks, but several months later, he was doing fine.

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