Pneumocephalus is defined as an intracranial gas collection. Most of the cases are secondary to trauma or are iatrogenic. Spontaneous, intraparenchymal non-traumatic pneumocephalus are extremely rare. In this article, we report a rare case of a 79-year-old female who presented in the emergency department with history of severe headache and nausea after a severe bout of cough .She had prior history of stroke 4 years back but no old history of any trauma or intracranial surgery. She was then advised MRI brain, which revealed a large gliotic area in the right occipital lobe with a large area of intraparenchymal pneumocephalus in left temporal lobe. Limited CT brain imaging confirmed no evidence of fracture. Due to the absence of history of prior trauma or surgery, the appearances noted on the CT scan were reported to be secondary due to sinus or middle ear disease. Patient was then advised HRCT temporal bone.
