Krishna Pravin, Gupta Malkeet
Department of Emergency Medicine, Antelope Valley Hospital, Lancaster, California.
Department of Emergency Medicine, Antelope Valley Hospital, Lancaster, California; Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, California.
J Emerg Med. 2015 Aug;49(2):e49-52. doi: 10.1016/j.jemermed.2015.02.011. Epub 2015 Apr 29.
Pneumorrhachis (PR), the presence of air within the spinal canal, is a rare, radiologic epiphenomenon arising from traumatic, nontraumatic, and iatrogenic causes. Often asymptomatic, PR is usually managed conservatively. However, PR can be associated with underlying serious pathology and can become symptomatic, requiring more aggressive diagnostic and treatment modalities from the treating physician. Although well known in the anesthesia literature, this case report is the first in the emergency medicine literature to describe iatrogenic, symptomatic PR presenting in the emergency department (ED).
A 34-year-old woman presented to the ED with a postural puncture headache after epidural anesthesia for a vaginal delivery. An epidural blood patch was administered, after which the patient acutely developed cervical radicular pain. Computed tomography angiography of the head and neck revealed epidural PR. Conservative treatment with analgesia, intravenous fluids, and bed rest was administered. Her pain improved significantly, and at 5-month follow-up, she remained symptom-free. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: PR is a rare and usually benign disease, especially in the setting of an iatrogenic cause such as lumbar puncture. However, in traumatic settings, PR in the intradural space should alert the emergency physician to search for underlying serious pathology if it has not already been found. Finally, PR can become symptomatic, and treatment will depend on the severity of symptoms.
椎管内积气（PR）是一种罕见的影像学偶发现象，可由创伤性、非创伤性和医源性原因引起。PR通常无症状，一般采用保守治疗。然而，PR可能与潜在的严重病理状况相关并出现症状，这就需要治疗医生采取更积极的诊断和治疗方式。尽管在麻醉学文献中已广为人知，但本病例报告是急诊医学文献中首例描述在急诊科出现的医源性、有症状的PR。
一名34岁女性在硬膜外麻醉下进行阴道分娩后，因体位性穿刺头痛就诊于急诊科。给予硬膜外血贴治疗后，患者突然出现颈部神经根性疼痛。头颈部计算机断层扫描血管造影显示硬膜外PR。给予镇痛、静脉补液和卧床休息的保守治疗。她的疼痛明显改善，在5个月的随访中，她仍无症状。急诊医生为何应了解这一情况？：PR是一种罕见且通常为良性的疾病，尤其是在腰椎穿刺等医源性情况下。然而，在创伤情况下，如果尚未发现潜在的严重病理状况，硬膜内空间的PR应提醒急诊医生进行排查。最后，PR可能会出现症状，治疗将取决于症状的严重程度。
