Cerebral Air Embolism

Abstract

We discuss five patients who had cerebral air embolisms. Clinically, these patients had early seizures, focal neurological findings, or failure to awaken from anesthesia. The patients that survived had minimal neurological deficits. We also discuss the pathophysiology of cerebral air embolism and its differentiation from "the bends." The necessity for recognizing this entity early is important in order to administer appropriate therapy.

Symptomatic Cerebral Air Embolism During Stent-assisted Coiling of an Unruptured Middle Cerebral Artery Aneurysm: Intraoperative Diagnosis and Management of a Rare Complication

“…Several sources for air emboli in the setting of cerebral angiography have been reported in the literature, including air bubbles in the flush syringe, air bubbles in improperly primed flush tubing, non-degassed pressure bag, accidentally opened 3-way stopcock during an episode of hypotension, and rupture of an inadequately degassed angioplasty balloon 2)4). In our case, air was introduced from the pressure bag, which had been inadequately degassed prior to the procedure; when the pressure bag was depleted, the small amount of residual air in the bag subsequently moved into the drip line, the guide wire, and eventually into the cerebral vasculatures.…”

“…The prognosis of CAE depends on a combination of several factors, including the amount of air present, collateral circulation, time of diagnosis, time of intervention, and treatment strategies utilized. Many patients with CAE can have complete recovery; however, permanent neurological injuries and mortality can also occur if diagnosis and proper intervention is delayed 1)2)3)4)5)6)…”

Chronological Changes in Cerebral Air Embolism That Occurred during Continuous Drainage of Infected Lung Bullae

“…Menkin and Schwartzman [9]suggested that air may dissipate within minutes by transversing the capillary bed to enter the venules, while Pierce [10]indicated that air may physically block blood flow for up to 48 h. Interestingly, we were able to observe the transfer of air within the cerebral vessels on CT scans; air density streaks were observed along the frontal gyri 1 h after the onset of embolism, then multiple air densities were observed in the deep cortical area 2.5 h after the onset, and the air densities in the deep cortex were reduced 24 h after the onset. In the literature, air densities along the superficial subarachnoid space and in the deep cortical area were observed in CT scans obtained 0.5–1 h [6, 7, 11]and 3–30 h [11, 12, 13, 14, 15]after the onset, respectively.…”

“…However, the observation that the caliber of air density is larger than the tangential plane of the artery seems to support the possibility that deep cortical veins were expanded with air 2.5 h after the onset, although the size of the air densities on CT may be influenced by the partial volume effect. In addition, since T 2 -weighted MR images indicated not only cortical infarction, but also extensive edema in white matter in the right frontal lobe, deep venous obstruction as well as transient arterial occlusion and/or vasospasm by air emboli [9]may have contributed to the evolution of cerebral infarction.…”

Arterial air embolism: structural effects on the gerbil brain.

“…4,6,10). Temporal discrepancy between these phenomena has been observed in experiments with middle cerebral artery occlusion in cats.…”