A Case of Pneumocephalus on Valsalva Maneuver: A Case Report and Literature Review

BACKGROUND Pneumocephalus is defined as the presence of air within the cranial cavity. Spontaneous onset is rare, with most cases arising secondary to head trauma or surgical procedures. The most common symptom is headache, a frequent concern in the emergency department, with a broad differential diagnosis. The diagnosis is based on a simple brain computed tomography (CT), while the etiological assessment involves magnetic resonance imaging (MRI) and consultation with otorhinolaryngologists. Most cases of pneumocephalus can be managed conservatively; however, some require urgent surgical intervention. CASE REPORT We report the case of a 45-year-old woman with no history of recent trauma or neurosurgical procedures who developed a sudden-onset occipital headache following a Valsalva maneuver. The pain worsened with head movement. Neurological and otorhinolaryngological examinations were unremarkable. Brain CT revealed a small, isolated pneumocephalus localized to the posterior fossa. No anatomical defect was identified on CT and MRI. The patient was managed conservatively. Her symptoms progressively resolved, and follow-up imaging demonstrated spontaneous resorption of the intracranial air. The favorable course suggests spontaneous closure of a potentially Valsalva-induced intracranial sinus cavity. CONCLUSIONS This case highlights the importance of neuroimaging in patients presenting with atypical headaches in the emergency department. Despite its rarity, pneumocephalus remains an underrecognized condition in emergency medicine. In addition to describing an unusual presentation, this report includes a review of previously published cases of Valsalva-induced spontaneous pneumocephalus and contributes a further example to the limited literature on this subject.