Pneumorrhachis: A rare cause of headache in a patient with a traumatic spinal cord injury due to gunshot wound

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2022.2124943 · Published: May 1, 2023

Simple Explanation

A pneumorrhachis (PR) is a rare condition where air is found in the spinal canal. This air can enter due to various reasons, including trauma. Most traumatic cases of pneumorrhachis are symptom-free and resolve on their own. However, in some instances, the air causes symptoms and necessitates immediate surgery. This case report describes a patient who developed a headache as the primary symptom of a traumatic pneumorrhachis following a gunshot wound and spinal cord injury.

Study Duration

Not specified

Participants

1 patient: 17-year-old male with paraplegia due to gunshot wound

Evidence Level

Case Report

Key Findings

1
Headache can be the main symptom of a subarachnoid pneumorrhachis, which is an unusual presentation of this condition.
2
A vertebral fragment may gradually migrate to a location that creates a dural tear, allowing air to leak into the spinal canal, leading to a CSF leak.
3
The patient's pneumorrhachis was located in the intrathecal space, likely indicating a subarachnoid pleural fistula, demonstrating the injury's severity.

Research Summary

This case report describes a 17-year-old male who developed a headache as the primary symptom of a traumatic pneumorrhachis following a gunshot wound and spinal cord injury. The patient underwent surgery to repair a dural tear and theco-pleural-broncho-fistula, which led to the resolution of his headaches. The case highlights the importance of considering rare conditions like pneumorrhachis in patients with spinal cord injuries who present with headache, even when other potential causes exist.

Practical Implications

Diagnostic Awareness

Clinicians should consider pneumorrhachis as a possible cause of headache in patients with spinal cord injuries, especially those with a history of trauma.

Prompt Intervention

Subarachnoid pneumorrhachis requires urgent attention and neurosurgical intervention to address underlying causes such as dural tears or fistulas.

Differential Diagnosis

Maintain a broad differential diagnosis for common symptoms like headache in patients with complex medical histories and multiple potential contributing factors.

Study Limitations

1
Single case report limits generalizability.
2
The exact timing of the pneumorrhachis development is unclear.
3
The presence of papilledema was not clinically confirmed with ophthalmoscopic examination.

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