A 69-year-old woman developed status epilepticus, after which there was a progressive deterioration of consciousness. Imaging studies revealed tension pneumocephalus along with intraspinal pneumorrhachis, a rare and highly lethal condition. Abdominal CT confirmed intestinal obstruction and perforation of the gastrointestinal tract. Cerebrospinal fluid culture showed polymicrobial infection, which suggested purulent meningoencephalomyelitis due to intra-abdominal infection. Blood cultures were negative. Despite aggressive treatment, the patient developed a bilateral infarction of the cerebral hemispheres and cerebral herniation, to which she succumbed. The infection spread by an unusual route from the abdominal cavity to the central nervous system, accompanied by significant radiological findings of air in the skull and spine. The case highlights the need for clinical vigilance in such rare conditions.