# Concurrent spontaneous pneumocephalus and pneumorrhachis due to polymicrobial infection: a case report

## TL;DR

A rare case of simultaneous brain and spinal air accumulation due to a severe abdominal infection is reported, highlighting the importance of early detection.

## Contribution

This case report presents a rare polymicrobial infection pathway from the abdomen to the central nervous system with concurrent pneumocephalus and pneumorrhachis.

## Key findings

- The patient had tension pneumocephalus and intraspinal pneumorrhachis due to polymicrobial CNS infection.
- The infection originated from gastrointestinal perforation and intestinal obstruction.
- Despite treatment, the patient developed cerebellar infarction and cerebral herniation, leading to death.

## Abstract

Intracranial pneumocephalus combined with intraspinal pneumorrhachis represents a scarce and highly lethal condition. We report the case of a 69-year-old woman who initially presented with status epilepticus, followed by progressive deterioration of consciousness. Imaging studies revealed tension pneumocephalus with concurrent intraspinal pneumorrhachis. Abdominal computed tomography (CT) demonstrated intestinal obstruction and gastrointestinal perforation. Although blood cultures yielded negative results, cerebrospinal fluid culture confirmed polymicrobial infection, suggesting purulent meningoencephalomyelitis secondary to intra-abdominal infection. The patient exhibited a complex clinical presentation with a rapidly progressive course. Despite aggressive treatment, she developed bilateral cerebellar hemispheric infarction and cerebral herniation, ultimately succumbing to the disease. This case is particularly noteworthy due to the unusual pathway of infection from the abdominal cavity to the central nervous system (CNS), accompanied by the distinctive radiological findings of both intracranial and intraspinal air accumulation. This report emphasizes the importance of clinical awareness and vigilance regarding such rare but life-threatening.