Concurrent spontaneous pneumocephalus and pneumorrhachis due to polymicrobial infection: a case report

Intracranial pneumocephalus combined with intraspinal pneumorrhachis represents a scarce and highly lethal condition. We report the case of a 69-year-old woman who initially presented with status epilepticus, followed by progressive deterioration of consciousness. Imaging studies revealed tension pneumocephalus with concurrent intraspinal pneumorrhachis. Abdominal computed tomography (CT) demonstrated intestinal obstruction and gastrointestinal perforation. Although blood cultures yielded negative results, cerebrospinal fluid culture confirmed polymicrobial infection, suggesting purulent meningoencephalomyelitis secondary to intra-abdominal infection. The patient exhibited a complex clinical presentation with a rapidly progressive course. Despite aggressive treatment, she developed bilateral cerebellar hemispheric infarction and cerebral herniation, ultimately succumbing to the disease. This case is particularly noteworthy due to the unusual pathway of infection from the abdominal cavity to the central nervous system (CNS), accompanied by the distinctive radiological findings of both intracranial and intraspinal air accumulation. This report emphasizes the importance of clinical awareness and vigilance regarding such rare but life-threatening.