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1Medical residents of Neurology, Department of Neurology, Federal Fluminense University, Niterói RJ, Brazil; 2MD, PhD, Professor of Neurology, Department of Neurology, Federal Fluminense University, Niterói RJ, Brazil; 3Ophthalmologist, Post-graduating program in Neurology and Neuroscience, Federal Fluminense University, Niterói RJ, Brazil; 4Radiologist at Antonio Pedro Hospital, Federal Fluminense University, Niterói RJ, Brazil. Correspondence: Victor de Almeida Kosac; Rua Doutor Paulo César 25 / apto. 1.608; 24240-000 Niterói RJ Brasil; E-mail: victorkosac@yahoo.com.br Conflict of interest: There is no conflict of interest to declare. Received 18 March 2012; Received in final form 26 November 2012; Accepted 03 December 2012. 1. Lefranc M, Peltier J, Demuynkc F, et al. Tension pneumocephalus and rhinorrhea revealing spontaneous cerebrospinal fluid fistula of the anterior cranial base. Neurochirurgie 2009;55:340-344. 2. Webber-Jones JE. Tension pneumocephalus. J Neurosci Nurs 2005;37: 272-276. References A 42-year-old woman presented with a sudden-onset severe headache associated with vomiting and a persistent aqueous rhinorrhea. She had an allergic chronic sinusitis. There was no history of head trauma. Neurologic exam disclosed papilledema. The computed tomography (CT) scan showed opacification of the left sphenoid sinus and pneumocephalus extending from frontal region until convexity, compressing the supratentorial ventricular system (Fig 1). The cerebrospinal fluid (CSF) fistula was found in the left pterygoid process (Fig 2). Air probably came through the dural defect, and may have followed the CSF flow circuit. The physiopathology can be explained by bone defect, absence of nasal mucosa, and minor traumas1,2.

Tension pneumocephalus and rhinorrhea related to chronic sinusitis