Spontaneous epidural pneumorrhachis in 14 years old

BACKGROUND: Pneumorrhachis is an exceedingly rare complication of pneumomediastinum as air tracks through tissue planes into the epidural (or subdural space). The majority of these patients present with a clear history of trauma, iatrogenic injury, pneumothorax, vomiting, or retching. CASE DESCRIPTION: A 14-year-old male presented with the asymptomatic spontaneous onset of pneumorrhachis associated with significant pneumomediastinum of unclear etiology. CONCLUSION: Most patients with pneumorrhachis present with nonfocal neurological examinations. For these patients, it is critical to rule out infection as the cause of epidural gas. If other systemic signs are present, then urgent contrast-enhanced magnetic resonance imaging should be obtained. The majority of patients will demonstrate spontaneous radiographic resolution of pneumorrhachis within several days.