Non-surgical resolution of pneumocephalus following a sneeze.

Pneumocephalus is defined as the abnormal presence of air in the intracranial cavity. Pneumocephalus is most commonly caused by trauma, but there are rare reports of pneumocephalus secondary to allergy-induced sinusitis. In this report, we present a woman in her 60s who presented to the emergency department with a chief complaint of headache after experiencing a 'popping' sensation in her ears while sneezing. Over the course of a day, she began experiencing severe pain across the forehead along with copious amounts of clear rhinorrhea. A head CT without contrast was ordered, and findings revealed large amounts of intracranial air visualised diffusely throughout the subarachnoid spaces and the anterior horn of the left lateral ventricle. A diagnosis of pneumocephalus was confirmed. This patient made a full recovery without surgical intervention. Standard conservative therapy included bed rest, head elevation, avoidance of activities that increase intracranial pressure and antibiotic prophylaxis for meningitis.

A Case of Digoxin Toxicity Due to Acute Renal Failure.

Since the publication of the Digitalis Investigation Group trial in 1997, digoxin use has declined significantly. Medications such as angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) and beta-blockers that have been demonstrated to have a decrease in morbidity and mortality are prescribed in favor of digoxin. Despite the reduction in digoxin use and improved therapeutic monitoring, digoxin toxicity remains a significant cause of morbidity and mortality. When digoxin toxicity is suspected, patients should be managed with supportive care, including discontinuation of the medication, and consideration for administration of digoxin-specific antibody fragment. We present a case of digoxin toxicity precipitated by acute renal failure, with a discussion on the pathophysiology and diagnosis of digoxin toxicity, along with the indications for administration of digoxin-specific antibody fragments. While digoxin toxicity is prescribed less commonly, physicians need to maintain a high index of suspicion and be comfortable with administering digoxin-specific antibody fragment in these scenarios.