Pneumorrachis and pneumocephalus associated with neck injury after stabbing

Trauma-related pneumocephalus and subcutaneous emphysema are relatively common, but pneumocephalus and pneumorrachis that occur without surgery are very rare. We present a case of pneumorrachis and pnemocephalus developing in the literature for the first time after stabbing from the anterior cervical region and providing improvement with conservative treatment.

A 42-year-old male patient was brought to the emergency department after stabbed in the neck. Anteromedial injury of the sternocloid muscle was followed by two lacerations with active bleeding from the same site. The patient was unconscious (Glasgow coma score 8(E2, M4, V2). The patient was intubated. Bleeding foci and lacerations were repaired in the emergency. Cranial, cervical, thoracic and lumbar non-contrast computed tomography scans were performed. Moderate pneumocephalus was seen in the subarachnoid space in the anterior of the bilateral frontal lobe and in the suprasellar cistern region. Pneumorrachis was seen in C2-C7 levels of cervical spinal canal. The patient was pentotalized. 100% oxygen treatment for 6 h was given from the ventilator in intensive unit. After 72 h, cranial, cervical, thoracic and lumbar CT were performed. Pneumorrachis and pneumocephalus were fully recovered.

Pneumorrachis is usually asymptomatic and is self-limiting. It is a radiological diagnosis and is not a clinical diagnosis. CT scan is considered the preferred diagnostic method for reliable and rapid detection of pneumorrachis. In case of coexistence, The physician should be alert to diagnose and treat the underlying cause for related injuries.In such cases, successful results can be obtained with hyper-oxy therapy (100% oxygen inhalation) and antibiotic prophylaxis without the need for surgical treatment.