Cushing's reflex due to spontaneous pneumocephalus after forceful nose blowing: A case report.
Allison N Seifert, Andrea L Klein, Roberta J Pritchard
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Case in brief
A patient presented with bradycardia, hypertension, and tachypnea after forcefully blowing her nose, leading to a diagnosis of acute pneumocephalus. CT imaging revealed extensive air presence around the brainstem and a tract connecting the external auditory canal to the infratentorial space, indicating pressure on the brainstem. Further evaluation identified a defect in the left round window as the source of air entry.
What made this case unusual
The case highlights the rare occurrence of pneumocephalus resulting from a forceful nose blow, which is typically asymptomatic but can lead to significant complications.
Diagnostic / clinical pearl
Clinicians should consider the possibility of pneumocephalus in patients presenting with altered sensorium and signs of increased intracranial pressure following nasal trauma or forceful maneuvers.
Why it matters
Understanding the mechanisms and potential complications of pneumocephalus can aid in timely diagnosis and management, preventing severe outcomes such as brainstem herniation.