Post-traumatic pneumorrhachis and pneumocephalus

Case contributed by Fakhry Mahmoud Ebouda


Alleged motor vehicle accident presenting to the ED with GCS 10. Leaking of CSF and blood from both ears.

Patient Data

Age: 19 years
Gender: Male

CT for this adolescent polytrauma patient showed: Longitudinal fractures of both petrous temporal bones more evident on the left involving the mastoid. Disrupting fracture of the sphenoid bone with hemosinus of the sphenoids and ethmoids, with consequent pneumocephalus and pneumorrhachis.Effaced cerebral ventricles and basal cisterns with no midline shift. Cerebral contusion of the left posterior parietal lobe as well as associated with subarachnoid hemorrhage. Follow up by CT two days later showed: absence of pneumocephalus and pneumorrhachis.

CT done for this adolescent polytrauma patient showed: in addition to the base of skull fracture with resultant pneumocephalus, gas is seen in the cervical epidural space and entire spinal canal that is named as pneumorrhachis. Partial anterior wedging of T12 vertebra with fracture of the right transverse process of L3.

Case Discussion

Pneumorrhachis or intraspinal gas (gas may present within the epidural or subarachnoid space) is quite rare. Hence the terminology epidural pneumatosis.

Our case is post-traumatic pneumorrhachis and pneumocephalus. On follow up CT two days later, it resolved spontaneously.  

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