Amara Bouchra, Boujraf Saïd, Benzagmout Mohammed, Labib Smael, Harandou Mustapha
Department of Pneumology, University Hospital of Fez, Fez, Morocco.
Department of Biophysics and Clinical MRI Methods, Faculty of Medicine and Pharmacy, University Hospital of Fez, Fez, Morocco.
J Glob Infect Dis. 2013 Oct;5(4):179-82. doi: 10.4103/0974-777X.122019.
Pneumorrhachis is the presence of air in the spinal canal; mostly, it has an iatrogenic origin. The association of this entity with spontaneous pneumomediastinum without any pneumothorax is rarely reported in the literature. The spontaneous resorption is the usual evolution. The association to acute transverse myelitis is discussed by the authors. The patient is a 21-year-old male with pneumorrhachis associated to a spontaneous pneumomediastinum was admitted at the emergency department for bacterial meningitis. The antibiotherapy has marked the clinical profile by disappearance of the meningeal signs in the 48 h after admission. In contrast, the neurological symptoms were of marked aggravation by appearance of a tetraparesis with a respiratory distress syndrome having required artificial ventilation. The computed tomography (CT) scan showed a typical hypodensity corresponding to paramedullary air extending to several thoracic segments. The spinal magnetic resonance imaging (MRI) showed a high cervical medullary edema without signs of compression. The patient died within 15 days with a profile of vasoparalysis resistant to vasoactive drugs. Pneumomediastinum associated to pneumorrhachis and transverse myelitis complicating purulent meningitis is a rare entity. Although the usual evolution is favorable, the occurrence of serious complications is possible.
椎管内积气是指椎管内存在气体，多数情况下其病因是医源性的。文献中很少报道这种情况与无气胸的自发性纵隔气肿相关。通常的演变过程是气体自发吸收。作者讨论了其与急性横贯性脊髓炎的关联。该患者为一名21岁男性，因与自发性纵隔气肿相关的椎管内积气入住急诊科，诊断为细菌性脑膜炎。抗菌治疗使临床症状有了明显改善，入院后48小时脑膜刺激征消失。然而，神经系统症状却显著加重，出现了四肢瘫并伴有呼吸窘迫综合征，需要进行人工通气。计算机断层扫描（CT）显示典型的低密度影，对应于髓旁气体延伸至多个胸段。脊髓磁共振成像（MRI）显示高位颈髓水肿，无受压迹象。患者在15天内死亡，表现为对血管活性药物耐药的血管麻痹。与椎管内积气和横贯性脊髓炎相关的纵隔气肿并发化脓性脑膜炎是一种罕见的情况。尽管通常的病情发展是有利的，但仍有可能发生严重并发症。
