Massive cerebral arterial air embolism following arterial catheterization

Yang, C. W.; Yang, Bin

doi:10.1007/s00234-005-1437-x

Cited by 20 publications

(16 citation statements)

References 15 publications

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“…We suspect in retrospect that the patient's initial presentation with status epilepticus was caused by cerebral air embolism that was missed clinically and by the initial head CT. Cerebral air embolism may not be well visualized on CT [1]. Reported causes of cerebral air embolism include cardiopulmonary bypass [2], endoscopic retrograde cholangiopancreatography [3], central venous catheter manipulation [4,5], contrast-enhanced computed tomography [6], radial artery catheterization [7], cardiopulmonary resuscitation [8], tracheal extubation [9], inadvert aircraft Non-contrast head CT shows massive intravascular air (white arrows) with diffuse cerebral edema and loss of gray-white matter differentiation (b, c) depressurization [10], cardiac ablation procedures [11], high frequency oscillatory ventilation [12], and cerebral and coronary angiography [13], [14]. None of these procedures or events preceded this patient's symptoms.…”

Section: Discussionmentioning

confidence: 98%

Fatal Massive Cerebral Air Embolism in a Lung Transplant Patient

2009

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Section: Discussionmentioning

confidence: 98%

Fatal Massive Cerebral Air Embolism in a Lung Transplant Patient

2009

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“…In the ED, CAE mainly presents in two distinct settings: 1) in the diving environment secondary to rapid ascent, causing nitrogen bubble formation or pulmonary barotrauma, leading to air emboli; 2) in the clinical setting, due to diagnostic or invasive interventions, causing iatrogenic air emboli introduction. Table 1 lists case reports of CAE with a variety of etiologies that could potentially present in the ED (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Cerebral Air Embolism after Esophagogastroduodenoscopy: Diagnosis and Management in the Emergency Department

Pandurangadu

Paul

Barawi

et al. 2012

The Journal of Emergency Medicine

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“…CT scan and MRI of the brain are usually confirmatory tests. In CAGE, CT demonstrates intraarterial air in 1 or both cerebral hemispheres, 13,14 but only macroscopic bubbles (1.3-mm radius) are identifiable and only if the CT slices, usually at 1-cm intervals, coincidentally intersect the appropriate level. 15 Therefore, absence of air on CT scan does not exclude the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Gas Embolism Caused by Pleural Fibrinolytic Treatment

Menéndez-González

Oliva‐Nacarino

Alvarez-Cofiño

2007

Stroke

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Background and Purpose-Intrapleural fibrinolytic therapy is a technique used to treat empyemas and parapneumonic effusions. Cerebral air embolism is an unusual potentially severe complication of this technique. Summary of Case-A patient with parapneumonic pleural effusion underwent pleural lavage with streptokinase when he suddenly demonstrated focal neurological signs and seizures. The CT revealed multiple air-isodense spots in right hemisphere of the brain, suggesting cerebral air embolism. As a result of early diagnosis and emergency hyperbaric oxygenation, the patient recovered without delayed sequelae. Conclusions-Air embolism is a potentially severe complication which can occur during fibrinolytic pleural lavage, and clinicians should be aware of this risk. In this context, the onset of acute focal neurological signs or seizures should suggest the possibility of air embolism and lead to the transfer of the patient close to a hyperbaric facility within a few hours. (Stroke. 2007;38:2602-2604.)Key Words: air embolism Ⅲ fibrinolytic therapy Ⅲ hyperbaric oxygenation Ⅲ stroke P arapneumonic effusions and empyema may complicate lower respiratory tract infections. In this condition, loculation of fluid is a major problem, and therapeutic options include conventional surgical drainage, video-assisted thoracoscopic surgery and the use of intrapleural fibrinolytic agents (urokinase and streptokinase) to break down fibrin bands that may cause loculation. 1-4 Although many physicians use fibrinolytic agents, the technique of instillation has not yet been standardized. 5 A Cochrane Systematic Review 6 evaluated the benefit of adding intrapleural fibrinolytic therapy to intercostal tube drainage in the treatment of complicated parapneumonic effusions and empyema. Controlled trials conducted up to 2003 were reviewed, concluding that intrapleural fibrinolytic therapy conferred significant benefits when compared with normal saline control. However, the routine use of fibrinolytic therapy cannot be recommended because the trial numbers were too small. A recent meta-analysis raised the same conclusions. 7 Remarkably, complications attributable to therapy were not observed at all in these trials, although several case reports of cerebral air embolism have been published. 8 -10 Herein we report a new case. Case ReportsA 50-year-old male patient, with a previous history of intestinal adenocarcinoma and resection of colorectal liver metastases developed a right purulent pleural effusion (Figure, A). He was admitted to hospital for daily pleural lavages with saline associated with streptokinase and for antibiotic treatment. During the third lavage he suddenly developed a generalized tonic-clonic seizure. Neurological examination showed a drowsy patient, with a conjugated gaze deviation toward the right, lower left facial paralysis, left hemiplegia and left Babinski sign. He immediately underwent a CT scan of the brain which revealed multiple air-isodense spots in the right hemisphere suggesting cerebral air embolisms (Figure, B)....

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Massive cerebral arterial air embolism following arterial catheterization

Cited by 20 publications

References 15 publications

Fatal Massive Cerebral Air Embolism in a Lung Transplant Patient

Fatal Massive Cerebral Air Embolism in a Lung Transplant Patient

A Case Report of Cerebral Air Embolism after Esophagogastroduodenoscopy: Diagnosis and Management in the Emergency Department

Cerebral Gas Embolism Caused by Pleural Fibrinolytic Treatment

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