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Atypical Headache After Prolonged Treatment With Nasal Continuous Positive Airway Pressure


  • Allan L. Bernstein MD,

  • John Cassidy MD,

  • Robert Duchynski MD,

  • Stephen S. Eisenberg MD

  • From the Departments of Neurology (Drs. Bernstein and Cassidy); Emergency (Dr. Duchynski); and Medical Imaging (Dr. Eisenberg), Kaiser Permanente Medical Center, Santa Rosa, CA.

Address all correspondence to Dr. Allan L. Bernstein, Department of Neurology, Kaiser Permanente Medical Center, 401 Bicentennial Way, Santa Rosa, CA 95403.


We report a case of atraumatic pneumocephalus associated with prolonged use of nasal continuous positive airway pressure. Initial symptoms included headache, ataxia, vertigo, and a “gurgling” sensation in the head; and a CT image showed small air bubbles along the falx of cerebrum and adjacent to the temporal epidural spaces bilaterally. Although no evidence of cerebrospinal fluid (CSF) leak was either reported by the patient or found at initial clinical examination, subsequent nasal discharge tested positive for β2-transferrin, a finding consistent with CSF leak in the paranasal sinus region or through the cribriform plate. To try to prevent infection from an open communication between the paranasal sinuses and intracranial structures, an attempt should be made to localize the anatomic defect.

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