Pneumorrhachis and pneumocephalus resulting from pneumothorax: illustrative case

Abstract

BACKGROUND Pneumorrhachis and pneumocephalus are rare conditions in which air is found within the spinal canal and brain, respectively. It is mostly asymptomatic and can be located in the intradural or extradural space. Intradural pneumorrhachis should prompt clinicians to search and treat any underlying injury of the skull, chest, or spinal column. OBSERVATIONS A 68-year-old man presented with a history of cardiopulmonary arrest together with pneumorrhachis and pneumocephalus following a recurrent pneumothorax. The patient reported acute headaches with no other neurological symptoms. He was managed conservatively with bed rest for 48 hours following thoracoscopic talcage of his pneumothorax. Follow-up imaging showed regression of the pneumorrhachis, and the patient reported no other neurological symptoms. LESSONS Pneumorrhachis is an incidental radiological finding that self-resolves with conservative management. However, it can be a complication resulting from a serious injury. Therefore, close monitoring of neurological symptoms and complete investigations should be performed in patients with pneumorrhachis.

Hamman syndrome with a rare feature of pneumorrhachis – an unusual complication of polysubstance abuse and e-vaping

“…Air can track its way through tissue planes and pleural layers, leading to the development of subcutaneous emphysema, pneumomediastinum, pneumopericardium and in rare instances, pneumorrhachis – defined as free air in the spinal cord. The positive pressure air especially in the posterior mediastinum drives air through neural foramina into epidural space, which lacks fascial layer protection [ 7 ] . Similar to our patient, reports of pneumorrhachis as a consequence of marijuana, cocaine and MDMA (3,4 methylenedioxymethamphetamine) ‘ecstasy’ smoking have also been reported [ 8 ] .…”