An 84-year-old man in Ireland stunned doctors when scans revealed that he seemed to be missing a large chunk of his brain.
He had reported feeling unsteady over the past several months, culminating in repeated falls in recent weeks.
"There was no confusion, facial weakness, visual or speech disturbance", doctors stated in a summary of the man's case published February 27 in the medical journal BMJ Case Reports.
Still, there were no red flags in the man's medical history.
A CT scan revealed the pressurized air pocket where his right side of the brain should have been. He didn't smoke. He rarely drank. He was otherwise fit and well, independent with physical activities of daily living (PADLs) and lived at home with his wife and two sons.
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Routine blood tests and regular health checks he undertook also failed to detect any sort of deformity, despite the huge hole inside his head. Dr Finlay Brown, study co-author and physician at Causeway Hospital, told Newsweek.
But as with any surgery, there would be some risks for the patient. When doctors were told that neither of these scenarios applied to the patient, they were "left very curious as to the cause of these findings", Brown said.
In this case, the patient's pneumatocele - or pressurised air cavity - measured about 3.5 inches at its longest, according to the BMJ Case Reports article.
"To find a pocket of this size in an organized fashion was extremely uncommon, with very few documented cases found while I was researching for writing up the case report", Brown added.
The pneumocephalus, in this case, was caused by an osteoma, a benign bone tumor, that formed in the patient's sinuses and eroded through the base of his skull.
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The MRI also revealed that the patient had experienced a small stroke related to the air pocket in his brain. Brown declared that his left-sided weakness was unrelated to the pneumocephalus but rather the side-effect of a minor brain stroke.
After consulting with specialists about surgery to release the air and remove the bone tumor, the man opted to skip any such intervention, given the risks. For example, decompressing the brain area could have led to more problems, and the surgery might not have helped the patient's symptoms, Brown said.
Brown said he had never seen a case of brain pneumatocele tied to symptoms of falling, and he made a decision to publish this case to emphasize "the importance of thorough investigation of even the most common of symptoms", Brown said. In a 12-week follow-up, the man was reported to be doing fine and his left-side weakness had cleared up.
"Because every now and then", Brown told LiveScience, "there will be a rare (or) unknown causation of these that could be overlooked".
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