Razavi Journal of Medicine

Razavi Journal of Medicine

Pneumocephalus and Neurologic Deficit Due to Neck StabWound in a Twenty Nine-Year-OldMan

Document Type : Case Report/Series

Authors
Toktam Mohammadi Rana
Behrang Rezvani Kakhki
Nasim Choobdari
Hosein Zakeri
Department of EmergencyMedicine, Faculty of Medicine,Mashhad University of Medical Sciences,Mashhad, Iran
10.30483/rijm.2016.118397
Abstract
 Introduction: The presence of air within the intracranial cavity, due to the entry of air secondary to an abnormal communication after a dural tear, is defined as pneumocephalus and intraventricular pneumocephalus also known as pneumoventricle. Obviously, common etiologies of pneumocephalus are head injury and cranial surgery. Also, less common non-traumatic causes of pneumo- cephalus are neoplasm or from a gas-forming organism infection. Although pneumocephalus after spinal penetrating injuries is rare,it was reported. The object of this report is to describe the case of patient with pneumoventricle after neck spinal stab wound.
 
Case Presentation: A 29-year-old man presented to ED with complaint of two stab wounds, one of them was located at the right back chest and the other at themidline neck. Because of the respiratory distress and decreased breath sounds, after taking a chest X-ray, we realized hemothorax in right hemithorax and placed the chest tube in ED. In addition, in requested neck CT scan, there was a defuse air in neck spine that spread to his brain. Furthermore, neurologic examination showed weakness in left leg motor function and loss of pain and temperature sensation in the other leg, which was based on brown-sequard syndrome. Mentioned patient admitted in neurosurgery department for further follow-up.
 
Conclusions: Pneumoventricle is rare but it can be established after spinal trauma. By awareness of such possibility, accurate diag- nosis by clinical examination and imaging is essential for these types of injuries
Keywords
Pneumocephalus
Pneumoventricle
Spine
StabWound

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

  1. 1.Yun JH, Kim YJ, Yoo DS, Ko JH. Diffuse pneumocephalus : a rare complication of spinal surgery. J Korean Neurosurg Soc. 2010;48(3):288–90. doi: 10.3340/jkns.2010.48.3.288. [PubMed: 21082062].

    1. Cuellar DC, Saenz HY, Fraino A. Pneumocephalus: Beyond its traumatic cause. European Soci Radiol. 2015.
    2. Kim YD, Lee JH, Cheong YK. Pneumocephalus in a patient with no cerebrospinal fluid leakage after lumbar epidural block - a case report. Korean J Pain. 2012;25(4):262–6. doi: 10.3344/kjp.2012.25.4.262. [PubMed: 23091688].
    3. Ajar AH, Rathmell JP, Mukherji SK. The subdural compartment. Reg Anesth Pain Med. 2002;27(1):72–6. [PubMed: 11799508].
    4. Valente MA, Bender EA. Severe pneumocephalus after penetrating injury to the lumbar spine. IJCRI. 2012;3(4):23–5.
    5. Rahamimov N, Mulla H, Freiman S. Cerebrospinal fluid leakage and pneumocephalus secondary to spine stab wounds. J Orthop Traumatol. 2010;11(1):57–9. doi: 10.1007/s10195-009-0070-6. [PubMed: 19915795].
    6. Bunc G, Roskar Z, Vorsic M. Pneumocephalus secondary to a neck stab wound without neurologic injury in a 13-year-old girl. Pediatr Neurosurg. 2001;34(5):239–41. [PubMed: 11423773].
    7. Guthkelch AN, Fleischer AS. Patterns of cervical spine injury and their associated lesions. West J Med. 1987;147(4):428–31. [PubMed: 3318136].
    8. Maroon JC, Abla AA. Classification of acute spinal cord injury, neurological evaluation, and neurosurgical considerations. Crit Care Clin. 1987;3(3):655–77. [PubMed: 3332218].
    9. Kobayashi N, Asamoto S, Doi H, Sugiyama H. Brown-Sequard syndrome produced by cervical disc herniation: report of two cases and review of the literature. Spine J. 2003;3(6):530–3. [PubMed: 14609700].
    10. Ahn S, Ko YS, Lim KS. Ventricular pneumocephalus with meningitis after lumbar nerve root block. Case Rep Emerg Med. 2013;2013:640185. doi: 10.1155/2013/640185. [PubMed: 23762659]. 12. Goncalves MB, Nunes CF, Melo Jo Jr, Guimaraes RD, Klescoski J Jr, Landeiro JA. Tension pneumoventricle after resection of a fourth ventricle choroid plexus papilloma: An unusual postoperative complication. Surg Neurol Int. 2012;3:116. doi: 10.4103/2152-7806.102325. [PubMed: 23226603].
    11. Miranda P, Gomez P, Alday R, Kaen A, Ramos A. Brown-Sequard syndrome after blunt cervical spine trauma: clinical and radiological correlations. Eur Spine J. 2007;16(8):1165–70. doi: 10.1007/s00586-007- 0345-7. [PubMed: 17394028].
Razavi Journal of Medicine
Volume 4, Issue 4
Autumn 2016
Pages 37-39