Extensive Pneumorrhachis After Spontaneous Pneumomediastinum

Bally, Kerri; Leikin, Scott; Margetis, Konstantinos; Reynolds, Alexandra S.

doi:10.1016/j.wneu.2020.07.091

Cited by 6 publications

(11 citation statements)

References 5 publications

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“… 52–63 The presence of these predisposing factors along with signs and symptoms should raise the suspicion for spontaneous pneumomediastinum (SPM) and possible pneumorachis. 64 SPM is more common among children and adolescents compared to older age groups. Males are more likely to be affected, and so does a tall, lean body habitus.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Pneumorachis – A Case-Based Review

Venkataramanan¹,

George²,

Sahu³

2021

JAA

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Pneumorachis is characterized by the presence of free air in the spinal canal. It is referred by different names in literature such as epidural emphysema, intraspinal air, intraspinal pneumoc(o)ele, spinal epidural and subarachnoid pneumatosis, spinal and epidural emphysema, aerorachia, pneumosaccus, air myelogram, etc. Pneumorachis can be broadly classified as traumatic, iatrogenic, or spontaneous. In this case-based review, we present a case of spontaneous pneumorachis secondary to asthma exacerbation. This is followed by a systematic review of all cases of spontaneous pneumorachis identified in PubMed. The aim of this review is to understand the pathophysiology, common causes and the management of spontaneous pneumorachis.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Pneumorachis – A Case-Based Review

Venkataramanan¹,

George²,

Sahu³

2021

JAA

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“…[15] In instances where pneumomediastinum, pneumothorax, perforated bowel or esophageal rupture have occurred, the proposed pathophysiology for development of PNR is tracking of air through the neural foramina into the spinal canal. [1,3] ere are no pathognomonic signs or symptoms associated with PNR. ere have been cases reported with neurological symptoms in the setting of iatrogenic and traumatic PNR secondary to cord compression.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] While many cases have no definitive cause, the most commonly identified causes are trauma and iatrogenic introduction of air, either following a procedure accessing the spinal canal such as a lumbar puncture or spinal surgery, or as a complication due to procedures such as aberrant chest tube. [ 3 , 4 ] Additional risk factors for the development of PNR include asthma, inhalational drug use through increased in intrathoracic pressure (with cases documented following marijuana smoking and 3,4-methylenedioxymethamphetamine (“Ecstasy”) inhalation), sacral pressure sore, sacral myelomeningocele, enterocutaneous fistula, influenza, leukemia, diabetic ketoacidosis, infection with gas-producing organisms, respiratory infection (particularly by mycoplasma pneumoniae, respiratory syncytial virus or influenza), airway obstruction from foreign body aspiration, perforated bowel and/or esophagus, and weightlifting. [ 3 , 6 , 11 , 13 ] Rarely, PNR can be a complication of spontaneous pneumomediastinum due to repeated, sustained Valsalva maneuver resulting in barotrauma.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 , 4 ] Additional risk factors for the development of PNR include asthma, inhalational drug use through increased in intrathoracic pressure (with cases documented following marijuana smoking and 3,4-methylenedioxymethamphetamine (“Ecstasy”) inhalation), sacral pressure sore, sacral myelomeningocele, enterocutaneous fistula, influenza, leukemia, diabetic ketoacidosis, infection with gas-producing organisms, respiratory infection (particularly by mycoplasma pneumoniae, respiratory syncytial virus or influenza), airway obstruction from foreign body aspiration, perforated bowel and/or esophagus, and weightlifting. [ 3 , 6 , 11 , 13 ] Rarely, PNR can be a complication of spontaneous pneumomediastinum due to repeated, sustained Valsalva maneuver resulting in barotrauma. [ 6 , 13 ] In addition, there exists two cases in the literature in which the patients had none of the aforementioned underlying risk factors; the cause for each was determined to be erosion in the annulus fibrosis with vacuum disc phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Holocord spontaneous pneumorrhachis in the setting of refractory emesis

Houston

Musch

Tayag

2021

Surgical Neurology International

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Background: Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly iatrogenic or traumatic in nature. Treatment is dependent on underlying cause and physical exam. Case Description: Herein, we describe the second case in the literature of spontaneous holocord PNR in a young patient without risk factors. A 22-year-old male with no past medical history presented to the hospital for 2 days of vomiting and cramping in his hands and feet secondary to severe dehydration. He recently started a new job as a manual laborer and had to leave work early 2 days prior due to overexertion working outside in heat ranging from 100 to 120 degrees Fahrenheit. CT abdomen and pelvis demonstrated spontaneous pneumomediastinum and extramedullary PNR extending upward from L3 throughout the thoracic spine to the upper limit of the scan. Subsequent CT cervical and thoracic spine showed the full length of the extradural air from C2-T12 and again at L3. Conclusion: Spontaneous PNR is an uncommon, typically self-limited condition in which air is introduced into the spinal axis. Anatomic predisposition makes the extradural, dorsal cord in the cervicothoracic region the most common location. Patients are rarely symptomatic, and treatment is supportive in nature once secondary causes with high rates of morbidity and mortality are ruled out.

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Pneumorrhachis From Esophageal Perforation Due to Cervical Osteophyte

McCarter

Johnson-Tesch

2022

JAMA Neurol

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Extensive Pneumorrhachis After Spontaneous Pneumomediastinum

Cited by 6 publications

References 5 publications

Spontaneous Pneumorachis – A Case-Based Review

Spontaneous Pneumorachis – A Case-Based Review

Holocord spontaneous pneumorrhachis in the setting of refractory emesis

Pneumorrhachis From Esophageal Perforation Due to Cervical Osteophyte

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