Clinical presentation following air travel - one or more of the following:
(1) headache
(2) signs of meningitis
(3) confusion or disorientation
(4) inappropriate behavior
(5) hemiparesis, hemiplegia or decreased level of consciousness
The onset is often while the plane is descending but can occur with any major change in cabin pressure.
The patient may or may not have risk factors for pneumocephalus such as:
(1) chronic otitis
(2) recent trauma
(3) recent neurosurgery or general surgery
(4) skull or brain tumor
(5) diverticulitis or colon cancer
The patient may not be able to give a medical history, so a high level of suspicion is needed to make the diagnosis.
Physical examination may show papilledema.
Diagnosis is usually made on an imaging study which demonstrates the intracranial air accumulation.
The differential diagnosis is airplane headache (see Chapter 17), but this is a recurrent condition.
