Presence of Gyriform Air Predicts Unfavorable Outcome in Venous Catheter–Related Cerebral Air Embolism

Cheng, Chih-Kuang; Chang, Ting‐Yu; Liu, Chi‐Hung; Chang, Chien-Hung; Huang, Kuo‐Lun; Chin, Shy-Chyi; Wu, Hsiu-Chuan; Chang, Yu-Ching; Lee, Tsong‐Hai

doi:10.1016/j.jstrokecerebrovasdis.2015.04.028

Cited by 13 publications

(19 citation statements)

References 33 publications

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“…The rare sporadic nature of this condition renders evaluation of treatment efficacy in a clinical setting problematic. The low incidence of adverse outcomes, variability of treatment protocols and non‐random treatment allocation precluded such analysis in this case series, and indeed even in humans, systematic reviews have not been able to draw any conclusions in this regard . Elucidation of the pathophysiology may however help identify rational therapeutic strategies.…”

Section: Discussionmentioning

confidence: 94%

“…The former 2 mechanisms, collectively termed “paradoxical” embolism, also could lead to coronary involvement, which could explain the arrhythmias and evidence of myocardial injury observed in some cases . Paradoxical embolism is thought to be the primary mechanism underlying cerebral air embolism in humans, although individual cases have been attributed to retrograde flow . The mechanism in horses has not been established.…”

Section: Discussionmentioning

confidence: 99%

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Catheter‐associated venous air embolism in hospitalized horses: 32 cases

Parkinson

McKenzie

Barton

et al. 2018

Veterinary Internal Medicne

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BackgroundVenous air embolism is a potentially life‐threatening complication of IV catheter use in horses. Despite widespread anecdotal reports of their occurrence, few cases have been reported in the literature and the prognosis is currently unknown.Hypothesis/ObjectivesOur objective was to describe the surrounding circumstances, clinical signs, treatment, progression, and outcome of venous air embolism in hospitalized horses.AnimalsThirty‐two horses with acute onset of compatible clinical signs associated with IV catheter disconnection or damage.MethodsMulticenter retrospective study. Data extracted from clinical records included signalment, presenting complaint, catheter details, clinical signs, treatments, and outcome.ResultsMost cases resulted from extension set disconnection occurring within approximately 24 hours after catheter placement. In fewer horses, extension set damage was cited as a cause. Common clinical signs included tachycardia, tachypnea, recumbency, muscle fasciculations and agitation, with abnormal behavior including kicking and flank biting. Less commonly, pathological arrhythmias or more severe neurologic signs, including blindness and seizures, were noted. Progression was unpredictable, with some affected horses developing delayed‐onset neurologic signs. Mortality was 6/32 (19%), including 2 cases of sudden death and other horses euthanized because of persistent neurologic deficits. Negative outcomes were more common in horses with recorded blindness, sweating or recumbency, but blindness resolved in 5/8 affected horses.Conclusions and Clinical ImportanceThe prognosis for resolution of clinical signs after air embolism is fair, but permanent neurologic deficits or pathologic cardiac arrhythmias can arise. Unpredictable progression warrants close monitoring. Systematic clinic‐based surveillance could provide additional useful information to aid prevention.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Catheter‐associated venous air embolism in hospitalized horses: 32 cases

Parkinson

McKenzie

Barton

et al. 2018

Veterinary Internal Medicne

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“…Other studies have confirmed the association between short time (<6 hours) to HBOT and improved neurological outcome . Furthermore, gyriform air on initial CT scan, old age, initial conscious disturbance, and hemiparesis are correlated to unfavorable outcome …”

Section: Discussionmentioning

confidence: 81%

“…10 Furthermore, gyriform air on initial CT scan, old age, initial conscious disturbance, and hemiparesis are correlated to unfavorable outcome. 11 The most common reason for a massive air embolism is a persistent foramen ovale (PFO). 7 In our patient, PFO could not be diagnosed with transthoracic echocardiography, and a transesophageal echocardiography was not conducted due to the risk of possible complications from an already injured esophagus.…”

Section: Discussionmentioning

confidence: 99%

Massive air embolism as a complication of upper gastrointestinal endoscopy: A case report illustrating a stroke mimic, literature review, and suggested management

Kjellberg

Nyström

Söderberg

et al. 2018

Clinical Case Reports

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“…Despite these measures, within published case reports there is a mortality rate as high as 22% 3 11. For cardiac arterial air embolism, direct aspiration has been applied, with some promising results 12 13.…”

Section: Discussionmentioning

confidence: 99%

Republished: Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration

Belton

Nanda

Alqadri

et al. 2016

J NeuroIntervent Surg

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Cerebral air embolism is a dreaded complication of invasive medical procedures. The mainstay of therapy for patients with cerebral air embolism has been hyperbaric oxygen therapy, high flow oxygen therapy, and anticonvulsants. We present a novel therapeutic approach for treatment of cerebral air embolism causing large vessel occlusion, using endovascular aspiration. Our patient developed a cerebral air embolism following sclerotherapy for varicose veins. This caused near total occlusion of the superior division of the M2 segment of the right middle cerebral artery. Symptoms included unilateral paralysis, unintelligible speech, and hemianopia; National Institutes of Health Stroke Scale (NIHSS) on presentation was 16. The air embolism was treated using a distal aspiration technique. Angiography following aspiration showed Thrombolysis in Cerebral Infarction 2B reperfusion. Following aspiration, the patient was re-examined; NIHSS at that time was 4. At 1 month follow-up, the modified Rankin Scale score was 1 and NIHSS was 1. Treatment of cerebral air embolism is discussed.

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Presence of Gyriform Air Predicts Unfavorable Outcome in Venous Catheter–Related Cerebral Air Embolism

Cited by 13 publications

References 33 publications

Catheter‐associated venous air embolism in hospitalized horses: 32 cases

Catheter‐associated venous air embolism in hospitalized horses: 32 cases

Massive air embolism as a complication of upper gastrointestinal endoscopy: A case report illustrating a stroke mimic, literature review, and suggested management

Republished: Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration

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