Endgames Spot Diagnosis

An unusual case of aphasia

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2792 (Published 29 June 2017) Cite this as: BMJ 2017;357:j2792
  1. Rebecca Mortimer, foundation year 2 doctor, emergency department1,
  2. Emma Owens, consultant radiologist1,
  3. David C Howlett, consultant radiologist1
  1. 1Eastbourne District General Hospital, East Sussex Healthcare Trust, Eastbourne, UK
  1. Correspondence to R Mortimer rmortimer1{at}nhs.net

A 93 year old man with a destructive scalp squamous cell carcinoma causing bony erosion into the calvarium was admitted with sudden onset aphasia. Neurological examination was otherwise unremarkable. A computed tomography (CT) scan was performed to investigate the cause of the aphasia (fig 1). What finding is present on the cranial CT?

Fig 1 Cranial computed tomography scan


The cranial CT shows extensive pneumocephalus (intracranial air).


The patient had pneumocephalus due to a bony defect at the level of his scalp tumour. As shown in fig 1 …

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