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Case report.
A 60-year-old right-handed man was transferred to our institution after a CT scan of the head showed air in both lateral ventricles. The scan was performed after the patient had a brief episode of presyncope on a warm day. On arrival he had no complaints. The only symptoms that could be elicited were a mild retro-orbital headache and bilateral tinnitus. Three months before hospitalization, he had taken a flight to South Africa. On landing in Johannesburg, he experienced the sudden onset of a severe rushing sound in both ears, which persisted although improved somewhat.
He had not had a lumbar puncture, and there had been no known trauma. He could not recall performing a Valsalva maneuver during the flight and denied rhinorrhea or otorrhea. His vital signs and general and neurologic examinations were …
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