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Case Reports
. 2020:68:174-177.
doi: 10.1016/j.ijscr.2020.02.063. Epub 2020 Mar 3.

Pneumorrhachis and hyponatremia after a neck hack-A case report

Affiliations
Case Reports

Pneumorrhachis and hyponatremia after a neck hack-A case report

Tommy Supit et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Penetrating cervical spinal cord injury (SCI) is a rare clinical entity that requires a multitude of health care specialists for proper management. The unpredictable nature of penetrating SCI and complex systemic sequela contribute to the high mortality rates of penetrating SCI.

Presentation of case: An 18-year-old-male patient was admitted to the emergency department with tetraparesis following a penetrating injury to the neck. Radiological examination revealed fractures of C4 and C5 spinous processes and extensive intradural pneumorrhachis. The patient was managed operatively with laminectomy, vertebral augmentation, and duroplasty. An acute decreased level of consciousness was observed four days after the operation. Laboratory investigation revealed critically low plasma sodium level. The patient remained decerebrated despite electrolyte correction and pronounced brain dead on the seventh postoperative day.

Discussion: Metabolic derangements and pulmonary physiologic changes following trauma are lethal complications. Hyponatremic encephalopathy and disrupted pulmonary function caused by high cervical compression by the extensive pneumorrhachis contributes to the morality in this case report.

Conclusion: This case report presents a rare clinical entity along with its' complications. Prompt clinical stabilization, strict biochemical monitoring, and multidisciplinary care from health care specialists are mandatory for SCI patients.

Keywords: Cervical; Penetrating; Pneumocele; Pneumorrhachis; Spinal cord injury.

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Figures

Fig. 1
Fig. 1
Radiological examinations A: Lateral cervical x-ray showing fractures of C4 and C5 spinous process (red arrow) and subcutaneous emphysema (white arrow). B: Sagital T1 cervical MRI showing subcutaneous emphysema anterior to the splenous capitis muscle (white arrow), disruption of soft tissue along the path of the blade that transected the spinal cord between C5-C6 and pneumorrhachis extending from C2–T1 (yellow arrows). C: Coronal T2 cervical MRI showing impaired cerebrospinal fluid flow caudal to the level of C2. D: Axial T1 cervical spine showing compression of the spinal cord due to trapped air (yellow arrow) within the spinal canal.
Fig. 2
Fig. 2
Intraoperative findings A: Tranverse penetrating wound measuring 1 cm. Considerable contamination of the subcuntaneous tissue was observed. B: The fractured spinous processes of C4–C5 and transverse C5-C6 intervertebral entrance wound. C: Laminectomy of C4–C6 revealed a 3 cm linear longitudinal disruption of the spinal dura mater. D: Post duroplasty, laminoplasty and full-augmentation of C4 and C6 with mini-plates.

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