Dados do Trabalho

Título

SPONTANEOUS PNEUMORRACHIA: a rare cause of stroke mimics.

RESUMO

CASE PRESENTATION
Female patient, 39 years old, was admitted to the emergency department of a private hospital in the city of São Paulo, after a severe headache followed by two episodes of syncope and motor deficit in the left upper limb. Neurological examination showed motor deficit in the left upper limb without sensitive impairment. She had previous history of bipolar affective disorder, chronic anemia, and overweight with previous bariatric surgery.
The patient was submitted to computed tomography (CT), arterial angiotomography of the skull and cervical neck, which showed rare small gaseous foci in the perivertebral soft tissues and extradural site on the left side in the craniovertebral transition, near the foramen magnum. Small foci of pneumocephalus were found in the posterior fossa, near the left sphenopetrous fissure. Electroneuromyography (ENMG) of four limbs was performed, with normal results, and brain and cervical magnetic resonance imaging (MRI) performed 48 hours after CT showed no more expression of the changes described on CT. She was treated with analgesia and was discharged with referral to rehabilitation service and outpatient follow-up.
DISCUSSION
Spontaneous pneumorrhachia is rare disease and is characterized by the presence of air in the spinal canal, both in the intradural and extradural compartments. It is usually benign with spontaneous resolution. Our patient was first suspected as having a stroke, due to the thunderclap headache and focal motor deficit. CT revealed the diagnosis
FINAL COMMENTS
Spontaneous pneumorrhachia is a rare cause of stroke mimics. Cervical CT should be carried out in patients with thunderclap headache and radicular pain in an upper limb.

Palavras Chave

Headache; strokemimic;