Pneumocephalus Secondary to Cerebral Air Embolism After Acute Bleeding in an Emphysema Bulla

Abstract

Pneumocephalus is the presence of air in the intracranial space and has multiple causes, including cerebral air embolism. Its presentation may range from asymptomatic to decrease mental status, coma, and seizures. We present a case of cerebral air embolism secondary to acute bleeding inside an emphysema bulla. A 69-year-old female was brought to the emergency room after suffering acute dyspnea, convulsions, and cardiac arrest during a commercial flight. The Head CT showed the presence of multiple small gas collections in the brain, and the Thoracic Angiotomography showed a thin-walled bulla surrounded with pulmonary venous vascular structures and signs of active bleeding. The patient had rapid neurological deterioration with evolution to brain death due to anoxic encephalopathy before the possibility of treatment with pulmonary lobectomy and hyperbaric oxygen therapy. It is important to identify the localization of pneumocephalus to determine its etiology and to deliver the best treatment. Cerebral air embolism may happen when air enters the arterial or venous system, which can cause brain damage due to capillary leak syndrome and local ischemia. Treatment of pneumocephalus includes treating the cause, bed rest, avoidance of Valsalva maneuvers, positive pressure, and hyperbaric oxygen therapy. Early recognition is essential to prevent complications such as irreversible brain lesions and to improve patient outcomes.

Cerebral air embolism after computed tomography-guided percutaneous transthoracic lung biopsy: a case description

“…In the case of cerebral air embolism, HBOT will replace our traditional acute reperfusion strategy ( 17 ). For patients without underlying respiratory disease, early use of HBOT is beneficial, and this treatment can be used continuously until symptoms do not improve further ( 17 , 18 ). If clinical symptoms and/or imaging indicate air embolism, the initial management includes stopping the surgery, initiating cardiopulmonary resuscitation if necessary, administering 100% oxygen, notifying the emergency care team, and commencing transfer to the intensive care unit.…”