Spontaneous Tension Pneumocephalus in a Patient with Recurrent Rhinosinusitis: A Case Report and Literature Review

Abstract Tension pneumocephalus is a rare and potentially life-threatening condition characterized by the presence of air within the cranial cavity, leading to increased intracranial pressure and compression of brain structures. However, the occurrence of tension pneumocephalus due to a spontaneous skull base defect in the absence of trauma or surgical intervention is exceedingly rare, and few cases have been documented in the medical literature. This report describes a rare presentation of spontaneous tension pneumocephalus in a 55-year-old female with no history of trauma, surgery, or chronic illness. Her clinical course was complicated by recurrent episodes of acute rhinosinusitis over the previous year, which may have contributed to the weakening of her skull base. Despite the absence of classical risk factors, imaging studies revealed a significant anterior skull base defect, resulting in air ingress into the intracranial cavity. Given the rarity of spontaneous skull base defects leading to pneumocephalus, especially in cases with no history of trauma, surgery, or chronic systemic illness, this report adds valuable insight that even a limited history of recurrent sinusitis may be a contributing factor in otherwise low-risk patients.