Cerebrospinal Fluid Leak and Pneumocephalus as Consequences of Sneeze Suppression: A Case Report and Review of the Litrature

Rare disease Background:Sneeze suppression creates a sudden pressure change that forces air or fluid through the weak points in the sinonasal walls -either the skull base or orbit -potentially leading to a cerebrospinal fluid (CSF) leak and pneumocephalus, both of which can resolve with conservative care.Spontaneous CSF leaks are often overlooked in patients without a history of trauma or prior skull base surgery. Case Report:A 45-year-old woman with no history of trauma or surgery presented with a 3-month history of recurrent headaches and clear nasal discharge from the left side.Upon further questioning, she admitted to frequently suppressing sneezing, particularly in public.Imaging studies revealed additional sinonasal abnormalities, a defect in the left cribriform plate, and scattered pneumocephalus.No evidence of infection or neoplastic pathology was identified.She underwent successful endoscopic skull base repair after conservative treatments failed.Postoperatively, she was advised to avoid activities associated with increased intranasal pressure.She was treated with acetazolamide, which was later discontinued.She experienced complete symptom relief and a successful surgical outcome over 1 year of follow-up. Conclusions:This case study emphasizes sneeze suppression as a rare but clinically significant cause of pneumocephalus and spontaneous cerebrospinal fluid leak.In the absence of trauma or previous surgery, patients presenting with unexplained rhinorrhea or intracranial air may benefit from an earlier diagnosis if this mechanism is recognized.Early radiological evaluation plays a crucial role in identifying skull base defects and guiding management.Potentially dangerous complications could be avoided with patient education and clinician awareness of safe sneezing techniques.