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|Year : 2015 | Volume
| Issue : 5 | Page : 800-801
Cervical pneumorrhachis secondary to a basal skull fracture
Mehdi Bellil1, Khaled Hadhri2, Anis Tebourbi1
1 Department of Orthopedics and Traumatology, Mongi Slim Hospital, La Marsa, Tunis, Tunisia
2 Department of Orthopedics and Traumatology, Charles Nicolle Hospital, Tunis, Tunisia
|Date of Web Publication||6-Oct-2015|
Dr. Khaled Hadhri
Department of Orthopedics and Traumatology, Charles Nicolle Hospital, Boulevard 9 Avril, 1006, Tunis
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bellil M, Hadhri K, Tebourbi A. Cervical pneumorrhachis secondary to a basal skull fracture. Neurol India 2015;63:800-1
A 25-year-old male patient, involved in a road traffic accident, was brought to the emergency. He was intubated shortly after admission because he was deeply unconscious with a Glasgow Coma Score of 5/15.
Cranial computed tomography (CT) showed a traumatic subarachnoid hemorrhage, a left frontal subdural hematoma, a right parietal subdural hematoma, and multiple fractures of the right parietal and temporal bone, zygomatic arch, mandible, and sphenoid sinus associated with pneumocephalus [Figure 1]; CT of the cervical spine [Figure 2] as well as lateral cervical plain X-ray [Figure 3] showed air in the spinal canal.
|Figure 2: Computed tomography sagittal reconstruction showing the epidural anterior pneumorrhachis extending to C7|
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|Figure 3: Lateral cervical spine radiograph showing air in the spinal canal|
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The patient was kept in the Intensive Care Unit and treated conservatively, while being sedated and ventilated. He soon developed bilaterally fixed, dilated pupils signifying brain death.
Pneumorrhachis (PR) is a condition characterized by air in the spinal canal, which is usually diagnosed incidentally while examining for other coincidental injuries and disease. The air can be detected by plain radiographs, a magnetic resonance imaging, and a CT scan. The latter is particularly helpful in detecting the air.
PR secondary to traumatic causes is rare, and is often associated with head, cervical, thoracic, abdominal and pelvic injuries, or a combination of different injuries including spinal trauma.
In this case, cervical PR was due to head trauma with the air entering the cervical canal by the cerebrospinal fluid pathway. There was no sign of vertebral, thoracic or abdominal trauma indicating any other mode of entry of this air into the spinal canal. Newbold et al., were the first to report a case of traumatic PR secondary to a basal skull fracture. PR can be classified descriptively into internal and intradural (intraspinal air within the subdural or subarachnoid space) and, external and extradural (intraspinal, epidural air) PR. PR in itself is often asymptomatic, usually does not migrate, and is reabsorbed spontaneously and completely with the air being passed directly into the blood over a course of several days without any signs of recurrence.
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Kim KY, Kang JH, Lee MH, Han Y, Choi DW. Atypical traumatic pneumorrhachis accompanied by paraparesis. Ann Rehabil Med 2014;38:410-4.
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Coskun S, Sahin M, Cobanoglu M, Kilicaslan I. Entire pneumorrhachis due to isolated head trauma. Am J Emerg Med 2009;27:902.e3-6.
[Figure 1], [Figure 2], [Figure 3]
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