A very rare case of otogenic pneumocephalus in a healthy 24-year-old m
an with a widely pneumatized right mastoid, precipitated by forceful V
alsalva's maneuver, is reported. When a pneumocephalus is suspected, c
omputed tomography scans are mandatory. The pertinent literature is di
scussed and the potential mechanisms causing spontaneous pneumocephalu
s are described. To the best of our knowledge, only two other similar
cases have been reported up to now.