Abstract

Pneumocephalus is defined as the presence of air in the epidural, subdural, subarachnoid, intraparenchymal or intraventricular region. There are many reasons in the etiology of pneumocephalus. Trauma, tumor, infection, nasosinusal or mastoid surgeries are some of these etiologies. However, the progress of spontaneous epidural pneumocephalus is rare. In this article, we report a 32-year-old female patient admitted with headache aggravated by Valsalva’s maneuver for 10 days, sudden pain in the left ear, fullness in the ears and vomiting, who had spontaneous epidural pneumocephalus arising from mastoid air cells associated with mastoid hyper-pneumatization. There was no history of head injury, ear infections or operations. Cranial non-enhanced computed tomography showed epidural air in the left parietal convexity and retro-cerebellum. There were connections between left mastoid cavity and epidural air. Additionally, pyramidal bone thinning and erosion with mastoid hyper-pneumatization were observed. Spontaneous pneumocephalus of mastoidal origin should be considered as a possible diagnosis in patients with headache aggravated by the Valsalva’s maneuver.