Clinical Reasoning: Pneumocephalus and pneumorrhachis in a 67-year-old man

Spontaneous Pneumorachis – A Case-Based Review

“…13 The patient in Gomez et al’s case report required vasopressor and broad-spectrum antibiotics for emphysematous pyelonephritis, as did the patient reported by Yamamoto et al 14 , 15 Schomig et al had to do a lumbar puncture followed by repair of enterodural fistula for the treatment of pneumorachis caused by enterodural fistula. 16 Mahajan et al’s patient required bronchoscopic removal of mucous plugging, while another patient of Saleem et al required bronchoscopy to diagnose pneumocystis pneumonia. 17 , 18 Fonseca et al also performed a bronchoscopy, although the reason for the procedure is unclear.…”

“… Kanu et al( 70 ) 19/m None Crack cocaine use Subcutaneous emphysema, pneumomediastinum. Conservative No Discharged 17 Schomig et al( 16 ) 67/m Diverticulitis s/p clipping Enterodural fistula caused by ingestion of dental prosthesis Pneumocephalus Lumbar puncture, vancomycin, ceftriaxone, Repair of entero dural fistual No Discharged 18 Mahajan et al( 17 ) 18/f Asthma Mucous plugging of the right main bronchus. Pneumomediastinum, subcutaneous emphysema, right pneumothorax Antibiotics, bronchodilators, bronchoscopic removal of mucous plugs.…”

Infectious Pneumorrhachis Due to Emphysematous Pyelonephritis

“…1,2 In this case, the gas extended beyond the renal parenchyma and collecting system into the spinal canal, causing pneumorrhachis, which is an unusual radiologic finding that is occasionally noted after spine trauma, spine surgery, or, more commonly, as a consequence of a vacuum phenomenon in the degenerative intervertebral discs. 3,4 Infectious pneumorrhachis is a rare neurologic complication of abdominal and retroperitoneal infections. Gas can dissect through the paraspinal soft tissues, such as psoas muscle, and gain access into the epidural space via the intervertebral disc, neural foramina, and neurovascular sheath through the venous plexus.…”

“…Emphysematous pyelonephritis is an infrequent but life-threatening infection that is caused by gas-producing bacteria, almost exclusively seen among people with poorly controlled diabetes . In this case, the gas extended beyond the renal parenchyma and collecting system into the spinal canal, causing pneumorrhachis, which is an unusual radiologic finding that is occasionally noted after spine trauma, spine surgery, or, more commonly, as a consequence of a vacuum phenomenon in the degenerative intervertebral discs …”