Unusual Case Report in BMJ: “The Man Who Lost (Part of) His Mind”

Here’s the abstract of a case report published February 27, 2018 in the British Medical Journal:

An 84-year-old man presented to the emergency department following recurrent falls over several weeks and onset of new left-sided weakness. CT of the brain revealed a large air cavity (pneumatocoele) in the right frontal lobe thought to be secondary to an ethmoidal osteoma communicating through the cribriform plate allowing air to be forced into the skull under pressure. Subsequent MRI confirmed these findings and also revealed a small focal area of acute infarction in the adjacent corpus callosum. The patient had a prolonged hospital stay, declined neurosurgical intervention and was discharged home on secondary stroke prevention.

This man suffered a “lower respiratory infection” (bronchitis, probably) in the hospital but was thoroughly evaluated and informed of his condition and the proposed treatment.  Major surgery would have been needed to correct this problem, in part because the osteoma was quite large and probably had been present for years.  The follow-up report (in the complete text of the case study, available free at the above link) stated that the man had survived twelve weeks post-hospitalization and felt well, with improvement in his left-sided weakness, which was caused by a small stroke (shown in the man’s corpus callosum– the band that connects the two halves of the brain– on his MRI scan.)  Apparently, he had a small benign bone tumor in his ethmoidal sinuses (these are behind the bridge of the nose) that broke through the cribriform plate (a bony plate with many tiny holes that pass nerves from the smell sensory nerves in the nose) and allowed air to enter a space that developed in the right side of the front of his brain.  The air space apparently had developed gradually, and was/is pressing on his brain, so far without causing damage… but eventually this will cause a serious problem.  The man, who at 84, apparently felt comfortable with the end of his life, declined surgery with its attendant risks and is still alive and ambulatory (walking around.)

If this sort of thing interests you, use the link to go to the report and peruse the MRI scan images– they are impressive.

(illustration courtesy of pixabay.com and OpenClipArt-Vectors)