Acute confusion secondary to pneumocephalus in an elderly patient

Presentation: an 83-year-old man was admitted to hospital with acute confus ion 3 days after a direct flight from Australia. Outcome: computed tomography (CT) brain scan and magnetic resonance imaging head scan revealed the cause to be pneumocephalus, apparently the result o f barotrauma caused by Valsalva manoeuvres when he attempted to unblock his nose during the flight. After 5 days of nursing in the vertical position t he patient's Abbreviated Mental Score returned to normal. A CT brain scan 6 weeks later showed complete resolution of the pneumocephalus.