bodyType

customContents

entityId

entityUuid

articlePageQuery

filter

article

articleBaseAdvertisingInfoArticle

articleListArticle

articleSeoArticle

hooksArticleAcknowledgementGateOverlayArticle

hooksTrackPageViewArticle

hooksContentInterestArticle

articleLinkingDataContent

hooksAmpRedirectArticle

articleSchemaContent

liveArticle

advertZone

sentiment

contentLock

topics

types

sections

paywallTypes

createdDate

publishedDate

urlAlias

moreOnThisArticles

sponsorType

commentCount

authorLocations

authors

corrections

displaySlideShow

multimediaEmbed

printHeadline

seriesContainer

articleSpeeches

socialHeadline

headline

images

flag

firstTopic

glossary

flattenTypeIds

image

relatedLinks

relatedNewsletters

__typename

sponsor

pdfFiles

seriesReverseOrder

series

disableOffPlatformContent

published

updatedDate

summary

subHeadline

body

keywords

readingTime

customTimezone

liveContents

The Washington Post

The 84-year-old man arrived in the emergency room with complaints that weren’t uncommon for a patient his age.
He had reported feeling unsteady over the past several months, culminating in repeated falls in recent weeks. In the three days leading up to his hospital visit, his left arm and leg had noticeably weakened.
Still, there were no red flags in the man’s medical history. He didn’t smoke. He rarely drank. A blood test detected nothing abnormal.
“There was no confusion, facial weakness, visual or speech disturbance,” doctors stated in a summary of the man’s case published on February 27 in the medical journal BMJ Case Reports. “He was otherwise fit and well, independent with physical activities of daily living . . . and lived at home with his wife and two sons.”
9 unanswered questions about the human brain
In other words, doctors thought, there was nothing apparent that would have suggested a clear reason for his symptoms. In a way, they wouldn’t be wrong.

It was only after CT and MRI scans that the patient’s medical team made an alarming discovery: Where much of the man’s right frontal lobe of his brain should have been, there was simply a large blank space.
This Indian man’s record-size brain tumour was so big it ‘sat like a head on top of another head’
Finlay Brown, a doctor who was working in the emergency department at Causeway Hospital in Coleraine, Northern Ireland, at the time, remembers reviewing the brain-imaging scans with the rest of the staff.
“[We] were all very perplexed by the images we saw!” Brown said.
The scans were so extreme, doctors wondered if the man had forgotten to disclose previous brain surgery or birth defects. He said he had not.
When [he] sniffed/sneezed/ coughed he would most likely be pushing small amounts of air into his head
Dr Finlay Brown
It turned out the man had pneumocephalus, or the presence of air in his skull, a condition that is found in “nearly 100 per cent of cases after brain surgery,” Brown said. It can also occur after sinus infections and head or facial injuries - but usually those pockets of air or gas are far smaller.
In this case, the patient’s air cavity measured about 8.9cm (3 1/2 inches) at its longest, according to the BMJ Case Reports article.
“In my research for writing the case report I wasn’t able to find very many documented cases of a similar nature to this one,” Brown said.
The air pocket’s likely cause, an MRI would show, was an osteoma, or benign bone tumour, that had formed in the man’s sinus and was eroding through the base of the skull, Brown said.
The tumour’s formation and location had allowed for something of a “one-way valve effect” that had gradually contributed to the cranial air cavity, he added.
“From speaking to the specialists, it seems it has been progressing insidiously over months to years,” Brown said. “When the patient sniffed/sneezed/coughed he would most likely be pushing small amounts of air into his head.”

The air cavity was also reported as a “rare cause” of a small stroke the man had suffered, which had likely led to the left-side weakness and other symptoms that prompted the man’s hospital visit, according to the BMJ Case Reports study.
Brown said the patient could have undergone surgeries. One that would decompress the air pocket in his head and another that would eliminate the tumour that had created the “one-way valve” and allowed air to move into the cavity in the first place.
However, the man declined both, because of his age and other health factors. He was given medication to prevent a secondary stroke and sent home with orders to monitor whether his left-side weakness worsened.
Best friends have exceptionally similar brain activity
His non-surgical approach is not without risk. It’s likely the patient will be at a greater risk for infection, since there remains a passageway for air - and therefore bacteria and viruses - into his brain cavity, Brown said.
“Unfortunately, as there are not many cases published, it is hard to know the exact prognosis,” Brown said.
So far, though, the man appears to be doing well, despite the cranial air pocket. During a follow-up appointment 12 weeks after his hospital visit, the patient reportedly no longer felt weakness on his left side and “remained well,” according to his case study.


As China grows, it is reshaping how global public goods are delivered

Worth the weight? What Hongkongers should know about slimming injections

How a vegan diet can help prevent and manage cancer, and the foods to focus on

No prescription, no problem: Hong Kong’s grey zone for weight-loss injections

Medicine

Doctors find giant air pocket where part of man’s brain should be

Doctors were shocked at the size of the air bubble that had taken up a large space in the man’s skull, pushing aside part of his brain. Photo: BMJ Case Reports

Diffusion-weighted MRI showing area of acute infarction. Photo: BMJ Case Reports

MRI of the head helped confirm the presence of pneumatocoele within the right frontal lobe. Photo: BMJ Case Reports

This Indian man’s record-size brain tumour was so big it ‘sat like a head on top of another head’

A handout picture released by the Department of Neurosurgery at Topiwala National Medical College, in Nair Hospital, Mumbai, shows 31-year-old Santlal Pal before undergoing surgery to remove a massive brain tumour. Photo: Agence France-Presse

Indian doctor Ramanuj Kabra points to brain scans of Santlal Pal, 31, at the BYL Nair hospital in Mumbai on February 22, 2018. Indian surgeons who removed a massive brain tumour in a marathon seven-hour procedure said on February 22 it could be the heaviest ever recorded. Santlal had been carrying around a tumour weighing nearly two kilos before the surgery on February 14. / AFP PHOTO / INDRANIL MUKHERJEE

This handout picture released by the Department of Neurosurgery Topiwala National Medical College, Nair Hospital on February 22, 2018 shows 31-year-old Santlal Pal after surgeons removed the brain tumour at Nair hospital in Mumbai. Indian surgeons who removed a massive brain tumour in a marathon seven-hour procedure said on February 22 they believe it could be the heaviest ever recorded. / AFP PHOTO / Department of Neurosurgery Topiwala National Medical College, Nair Hospital / Handout / -----EDITORS NOTE --- RESTRICTED TO EDITORIAL USE - MANDATORY CREDIT "AFP PHOTO / Department of Neurosurgery Topiwala National Medical College, Nair Hospital - NO MARKETING - NO ADVERTISING CAMPAIGNS - DISTRIBUTED AS A SERVICE TO CLIENTS - NO ARCHIVES

Santlal Pal, 31, rests in his bed as his wife Manju, feeds him a slice of apple at the BYL Nair hospital in Mumbai on February 22, 2018. Indian surgeons who removed a massive brain tumour in a marathon seven-hour procedure said on February 22 it could be the heaviest ever recorded. Santlal had been carrying around a tumour weighing nearly two kilos before the surgery on February 14. / AFP PHOTO / INDRANIL MUKHERJEE

Doctors find giant air pocket where part of man’s brain should be

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}The man’s air cavity in his head measured almost 9cm at its widest point

The man’s air cavity in his head measured almost 9cm at its widest point