Abstract Details

Title Pneumorachis and Pneumomediastinum Following Weight Lifting: A Case Report

Topic Sports Neurology

Presentation(s) IN5 - (-)

Poster/Presentation
Number 008

Objective

Background This case involves three very rare radiographic findings occurring simultaneously: pneumorachis, pneumomediastinum and pneumatization of the occipital bone. Non-traumatic pneumorachis is even more rare and has been associated with valsalva maneuvers, extreme exercise and pneumomediastinum.

Design/Methods Case Study.

Results A 58 year-old man was weight lifting three weeks prior to presentation. He noted neck pain involving his shoulders starting 24 hours after exercise and intermittent tingling of fingers bilaterally.Examination revealed tenderness over the C5-C6 spine as well as bilateral shoulders and increased pain with neck flexion, mildly brisk deep tendon reflexes of left biceps, brachoradialis, triceps, patella and ankle jerk as well as a patch of decreased sensation to pin prick in T5-T6 distribution. Cervical spine plain film showed pneumorachis, air in the spinal canal extending from the superior left occiput, along the right aspect of C2 and C1 and to T5 with pneumomediastinum. CT neck and chest revealed pneumatization of the clivus and occipital bone with soft tissue free air including epidural pneumatosis and canal stenosis. The patient was managed conservatively with rest and symptomatic pain relief. One week later repeat plan film images of the spine showed resolving pneumorachis.

Conclusions Pneumorachis is often asymptomatic but rarely presents with multiple radiculopathies and myelopathy due to compression of nerve roots or spinal cord. Intraspinal air is typically benign and resolves spontaneously. Some patients are treated with high concentration oxygen therapy for 24 hours but there is no evidence for the efficacy of this. Rarely pneumorachis can lead to spinal cord compression and may require neurosurgery in select cases but on the whole this is a benign, self-limiting condition with a remarkable radiographic appearance.

Authors/Disclosures
Katherine Turk, MD (Boston VA) PRESENTER	The institution of Dr. Turk has received research support from Alzheimer's Association. The institution of Dr. Turk has received research support from US Department of Veterans Affairs.
William Ondo, MD (Methodist Neurological Institute)	Dr. Ondo has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Neurocrine. Dr. Ondo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for ACADIA. Dr. Ondo has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie. Dr. Ondo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Kyowa Kirin. The institution of Dr. Ondo has received research support from Cerevel. The institution of Dr. Ondo has received research support from SCION. The institution of Dr. Ondo has received research support from Harmony. Dr. Ondo has received publishing royalties from a publication relating to health care.
	No disclosure on file
Kazutoshi Nishiyama, MD, PhD	Kazutoshi Nishiyama, MD, PhD has nothing to disclose.

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