The authors reported a case of
pneumocephalus induced by
bromocriptine (Bc) treatment for a recurrent invasive
prolactinoma. The patient was a 38-year old man, who had been treated for 12 years, with three times of
craniotomies and two times of irradiation
therapies. CT scan showed the recurrence of the
tumor, which extended into bilateral middle fossa, left orbit and left cerebellopontine angle. Serum
prolactin levels elevated to 35,200 ng/ml. Then Bc was administered in a dose of 5 mg/day. Serum PRL concentration fell to 2,090 ng/ml one month after the initiation of the treatment, when he complained of
headache,
nausea and
vomiting. Since these symptoms were considered as the side effects of Bc, the dose was reduced to 2.5 mg/day. Three weeks later, plain craniograms showed marked
pneumocephalus, while no
tumor was found on CT scan. The administration of Bc was stopped and he was prescribed a complete rest for a month. The air was collected again when he began to walk around. Therefore, the transsphenoidal operation was performed in order to pack the sella turcica and sphenoid sinus with muscle pieces. Since the
pneumocephalus could not be cured, the muscle, taken from the thigh, was spread throughout the left middle fossa by the front-temporal
craniotomy. When Bc reduces the size of the invasive
prolactinomas, the intra- and extra-cranial spaces may be communicated. The greatest care should be taken for
pneumocephalus,
CSF rhinorrhea and/or
meningitis during the Bc treatment of
prolactinomas.