title: Esophageal-subarachnoid fistula: a case of spontaneous tension pneumocephalus in the setting of esophageal cancer.
abstract: BACKGROUND
  Pneumocephalus occurs as a result of traumatic or iatrogenic violation of the dura. Tension pneumocephalus, whereby air continues to accumulate with no mechanism for escape, can cause significant morbidity and mortality.
  
  
  METHODS
  This case report reviews the underlying pathophysiology, clinical presentation, diagnosis, and management of tension pneumocephalus.
  
  
  RESULTS
  We present the case of a 68-year-old man who presented to the Emergency Department with headache thought to be the result of a newfound intracranial mass. After admission, he became obtunded and was found to have tension pneumocephalus requiring emergent evacuation. A cervical esophagus carcinoma caused an esophageal-subarachnoid fistula that resulted in tension pneumocephalus after a retching episode.
  
  
  CONCLUSIONS
  This case illustrates the importance of considering alternative sources of pneumocephalus in the absence of more typical differential diagnosis.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Mihir R
authors.initials: MR
authors.lastname: Patel
authors.forename: Winslo
authors.initials: W
authors.lastname: Idicula
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Prevedello
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000150:complications*; D019299:Decompression, Surgical / Q000379:methods; D004630:Emergencies; D004937:Esophageal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D004938:Esophageal Neoplasms / Q000150:complications*; D006261:Headache / Q000209:etiology; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D009367:Neoplasm Staging; D011007:Pneumocephalus / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011859:Radiography; D013346:Subarachnoid Space; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: chemoradiation; esophageal cancer; esophageal stent; pneumocephalus; tension pneumocephalus