200 Section - Pneumocephalus in the Setting of Spinal Cord Injury from a Penetrating Gun Shot Wound: A Case Report

Case Diagnosis: Pneumocephalus s/p SCI

Case Description: KR is a 33 yo Male who presented to level 1 trauma center after suffering a penetrating gunshot wound with retained ballistic fragment in the spinal canal at T12 which was managed nonoperatively. He was diagnosed with T11 AIS level A Spinal Cord Injury. Due to post-morbid onset neurologic deficits above the neurologic level of injury with irretractable headache and bilateral upper extremity weakness, CT Cervical spine imaging was obtained depicting a small foci of gas within the cervical spinal canal at C6 up to the central skull base consistent with pneumocephalus. Was managed conservatively with bed rest in acute care setting and the patient's upper extremity weakness and headache resolved allowing him to participate in inpatient rehabilitation.

Discussions: Pneumocephalus is the presence of air within the cranial cavity and, in the context of spinal cord injury, is a rare but potentially serious complication most often associated with dural tears and cerebrospinal fluid leaks. It can occur after spinal trauma or surgery, especially when there is a communication between the subarachnoid space and the atmosphere, and may be life-threatening if it progresses to tension pneumocephalus, which can cause brain herniation and rapid neurological decline. Management is typically conservative for uncomplicated cases: bed rest, high-flow oxygen therapy (to enhance nitrogen resorption), discontinuation of suction drains, and close neurological monitoring. Most cases resolve spontaneously within days to weeks. However, surgical intervention is indicated for persistent CSF leaks, neurological deterioration, or tension pneumocephalus (manifested by mass effect or rapid decline), which may require emergent wound exploration, dural repair, or, rarely, burr hole decompression.

Conclusions: Pneumocephalus is a rare but potentially life threatening sequela of spinal cord injury and should be considered as a potential cause of new onset neurologic deficits after a spinal cord injury secondary to a penetrating gunshot wound.