Volume 2, Issue 7 (Autumn 2016)                   Caspian.J.Neurol.Sci 2016, 2(7): 49-54 | Back to browse issues page


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Behzadnia H, Alijani B, Ramzannezhad A, Dehghani S. Traumatic Pneumorrhachis in a Young Male Motor Vehicle Accident Victim. Caspian.J.Neurol.Sci. 2016; 2 (7) :49-54
URL: http://cjns.gums.ac.ir/article-1-131-en.html
1- Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
2- Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran; babakalij@gmail.com
Keywords: Pneumorrhachis, Trauma
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ABSTRACT

Pneumorrhachis (PR), which involves the entrapment of air or gas within the spinal canal, is a rare clinical entity. The pathogenesis and etiology of this uncommon entity vary and may present a diagnostic challenge. Air in the spinal canal can be divided into primary and secondary PR, extra- or intradural PR and etiologically classified as iatrogenic, traumatic and non-traumatic. PR is typically asymptomatic but can be symptomatic–by itself or by its underlying pathology. The latter, although often severe, might be concealed and must be carefully examined to facilitate adequate patient treatment. Here we report a rare case of traumatic PR in a 28-year old man following a motor vehicle accident in northern Iran, who sustained paraplegia and sphincter dysfunction without any laceration and wound in the spinal area.

Keywords: Pneumorrhachis; Trauma

Introduction

Pneumorrhachis (PR) is characterized by air entrapped within the spinal canal, either in the epidural or intradural space[1]. It is a rare condition, generally associated with trauma and surgical procedures; there are various etiologies and possible pathways of air entry into the spinal canal[2]. The causes can be classified as iatrogenic, non-traumatic and traumatic, the last of which is most rare. Its precise mechanisms remain unknown. PR is typically asymptomatic and clinically non-specific. It does not tend to migrate, but it gets spontaneously reabsorbed into the bloodstream over a period of several days. Patients with PR are thus typically treated conservatively[3].

PR secondary to trauma is rare, though it has been observed in patients with bone fractures and spinal injuries. Pain and neurological injury is uncommon in these injuries,and they are oftendiagnosed incidentally by radiographic imaging, such as computed tomography (CT) scanning [2-6]. We report a rare case of traumatic PR accompanied by paraplegia by reviewing the other literatures.

Case Presentation

A 28-year old man was admitted to the hospital following a motor vehicle accident (MVA). He presented with a Glasgow coma scale of 12 (E4M5V3) and mid-sized pupil. On admission, he was unstable, with 80 mmHg systolic blood pressure and tachycardia. During physical examination, according tothe manualmuscle test, the muscular strength of his upper extremities was normal (5/5), with paraplegiaas a result of T11 fractureand cord injury, and tenderness of the thoracic spinal region. The patient complained of sphincter dysfunction in form of urinary incontinence. The skin surface was intact and there were no signs of penetrating wound.

The chest radiograph did not indicate rib fracture. Whole spine axis X-ray and CT were performed and a T11 seat belt-type fracture with Clay Shoveler's fracture of T1-T2 was revealed, with air entrapment from C3 to C7 of the spinal canal. Cervicothoracic MRI confirmed previous findings. (Figs 1-3).

AWT IMAGE

Fig1.Sagittal magnetic resonance imaging (MRI) demonstrates fracture of the T11

AWT IMAGE

Fig 2. Sagittal multilane reformatted spinal CT images demonstrating traumatic cervical PR (A). Axial CT scan of the cervical spine shows extradural air collection in the dorsal spinal canal.