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Abstract
Granulomatosis with polyangiitis (GPA) is a small-vessel vasculitis most commonly affecting the kidneys and respiratory tract. We report a case of a man in his 80s with known GPA presenting with gradually declining cognitive function over months, with sudden decreasing level of consciousness. A non-contrast CT of the head revealed severe pneumocephalus located in the left frontal lobe and in the ventricular system, due to erosion of the cribriform plate and a spontaneous dural perforation. The patient was immediately transferred to a neurosurgical department for insertion of an external ventricular drain. Surgical repair of the dural defect was subsequently performed through an endoscopic, endonasal approach using an autologous fascia lata graft. The patient gradually improved over the following days and had made a complete recovery 3 months after surgery.
- Coma and raised intracranial pressure
- Neuroimaging
- Vasculitis
- Neurosurgery
- Otolaryngology / ENT
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Footnotes
Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SL, KF, NR and AL-C. The following authors gave final approval of the manuscript: SL, KF, NR and AL-C. AL-C as guarantor accepts full responsibility for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.