Spontaneous pneumocephalus in a newborn infant with myelomeningocele and hydromyelia

Spontaneous Pneumocephalus Secondary to Leaking Myelomeningocele

Myelomeningocele is one among the most common forms of spinal dysraphism. We report a newborn male child with leaking myelomeningocele who presented with apneic spells. He underwent a magnetic resonance imaging of the neuraxis, which revealed Chiari malformation and severe hydromyelia along with pneumocephalus. He was planned to undergo urgent repair of the neural tube defect but his parents were not willing for surgery. We report this case as spontaneous pneumocephalus secondary to open neural tube defect, which is very rare and sparsely reported.

MRI of pneumorachis in a newborn infant with open myelomeningocele

Pneumorachis, or air within the spinal canal, is a very rare radiographic finding, frequently of traumatic origin. A newborn infant with an open lumbosacral myelomeningocele presented with severe paraparesis and an unexpected dysfunction of the brainstem with somnolence, irregular respiration, and motor deficits of the upper extremities. Magnetic resonance imaging revealed hypoplasia of the brainstem and cerebellum and low-signal lesions on T(2)-weighted images at the cervicocranial junction, in the lateral ventricles, and in the spinal canal. Computed tomography confirmed the presence of intracranial and intraspinal air. The air disappeared 2 weeks later according to magnetic resonance imaging, but no clinical improvement occurred, even after 6 months. Pneumorachis and pneumocephalus can occur in newborn infants as an unexpected complication of an open myelomenigocele, with or without signs. The radiographic appearance of intraspinal air on magnetic resonance imaging was not described previously.