We report a case of otogenic pneumocephalus in an 80-year-old woman with multiple myeloma. The pneumocephalus was associated with Haemophilus influenzae otitis media and reactive meningitis in the absence of an intracranial brain abscess. Myeloma causes thinning of bone trabeculae and destructive lytic bone lesions. This can predispose to a risk of pathologic fractures and, in patients with skull vault involvement, to the rare complication of pneumocephalus. Therefore, pneumocephalus should be considered in the differential diagnosis of acute headache in patients with multiple myeloma, especially those with skull vault involvement. Prompt computed tomography and liaison between the otolaryngology and neurology teams may assist in making an early diagnosis and preventing life-threatening intracranial complications.
Pneumocephalus, which literally means “air in the brain,” is an uncommon, potentially serious neurologic condition. It occurs via a breach in the cranial bones, often as a complication of sinusitis, otitis media, head and facial trauma, skull base tumors, or surgical interventions. Pneumocephalus associated with meningitis may occur as a complication of gas-producing organisms in brain abscesses or secondary to dural ruptures. We report a new case of otogenic pneumocephalus.
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