Retrograde cerebral venous air embolism: A rare cause of intracranial gas

Laurent, Pierre-Eloi; Coulange, Mathieu; Bartoli, Christophe; Louis, Guillaume; Souteyrand, P.; Gorincour, Guillaume

doi:10.1016/j.diii.2013.09.009

Cited by 11 publications

(11 citation statements)

References 6 publications

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“…Among the published cases of cerebral venous air embolism related to central catheter use, air was most frequently demonstrated in the cortical veins [ 30–33 ] and the cavernous sinuses [ 33–36 ]. Moreover, air emboli involving the cavernous sinuses [ 37–40 ] and the jugular veins [ 39 , 40 ] have also been reported after peripheral bloodline manipulations. Normally the valves in the jugular vein ensure unidirectional blood flow towards the heart.…”

Section: Pathophysiology and Clinical Manifestationsmentioning

confidence: 99%

Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters

Wong¹,

Kwaan²,

Ing³

2017

Clinical Kidney Journal

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Venous air embolism is a dreaded condition particularly relevant to the field of nephrology. In the face of a favourable, air-to-blood pressure gradient and an abnormal communication between the atmosphere and the veins, air entrance into the circulation is common and can bring about venous air embolism. These air emboli can migrate to different areas through three major routes: pulmonary circulation, paradoxical embolism and retrograde ascension to the cerebral venous system. The frequent undesirable outcome of this disease entity, despite timely and aggressive treatment, signifies the importance of understanding the underlying pathophysiological mechanism and of the implementation of various preventive measures. The not-that-uncommon occurrence of venous air embolism, often precipitated by improper patient positioning during cervical catheter procedures, suggests that awareness of this procedure-related complication among health care workers is not universal. This review aims to update the pathophysiology of venous air embolism and to emphasize the importance of observing the necessary precautionary measures during central catheter use in hopes of eliminating this unfortunate but easily avoidable mishap in nephrology practice.

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Section: Pathophysiology and Clinical Manifestationsmentioning

confidence: 99%

Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters

Wong¹,

Kwaan²,

Ing³

2017

Clinical Kidney Journal

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“…Paradoxical embolism is characterized by the air passage from the venous system to arterial circulation through the cardiac or pulmonary right-to-left shunts, such as patent foramen ovale and pulmonary arteriovenous malformations, respectively. Paradoxical embolism can also occur in the absence of right-to-left shunts due to certain factors, such as a large volume of intravascular air, use of vasodilators or anaesthetic agents, which facilitate air passage through pulmonary capillary beds by compromising the ability of pulmonary capillaries to filter out gas emboli ( 3 , 4 , 5 ). In the retrograde mechanism, air in the central venous circulation reaches the cerebral vasculature by moving in the opposite direction of the venous blood flow ( 5 , 6 ).…”

Section: Discussionmentioning

confidence: 99%

“…CVAE may manifest with various imaging appearances on CT. Cavernous sinuses are most often involved in retrograde air embolism ( 4 ). Cheng et al ( 6 ) described the patterns of CVAE according to the distribution of air in the brain as gyriform air, venous sinus air bubbles and parenchymal/subarachnoid space air bubbles.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Cerebral Air Embolism in a Patient with Intestinal Necrosis: A Case Report

2017

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Background: Cerebral venous air embolism is a severe clinical condition related to an unfavourable outcome in patients with neurological impairment. Cerebral venous air embolism may occur secondarily to arterial or venous interventions. A rare mechanism of cerebral venous air embolism is retrograde embolism, which is characterized by gas flow in a direction that is opposite to that of the normal blood flow.Case Report: A 69-year-old female was admitted to our hospital with shortness of breath and abdominal pain. Abdominal computed tomography revealed intramural gas in the bowel and free gas in the mesenteric veins and portal vein. Cranial computed tomography, which was performed due to impaired consciousness, demonstrated cerebral air embolism with the appearance of a gyriform pattern. A bedside echocardiography and chest computed tomography revealed no evidence of right-to-left shunt. Conclusion: Cerebral venous air embolism may occur after pneumatosis intestinalis by a retrograde flow of air from the mesenteric veins and portal vein. Low cardiac output and supine position are contributing factors for a retrograde flow of air bubbles into the venous circulation of the brain.

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“…However, air may also reach the cerebral veins via retrograde motion in the superior vena cava and/or jugular venous system, which is referred to as a retrograde embolism. Semi-seated or upright positioning, Valsalva maneuvers, and venous valve insufficiency have been offered as possible explanations for retrograde air flow within moving blood [1] .…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral venous air emboli typically occur secondary to iatrogenic or traumatic injury with vascular access being a leading iatrogenic cause [1] . They result from either retrograde passage of air emboli into the cerebral veins via the neck veins or through antegrade passage into the intracranial venous sinuses via the epicranial emissary veins.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic detection of air in the superior sagittal sinus in a neonate with transposition of the great arteries

Rivers-Bowerman

Litz

Schmit

2017

Radiology Case Reports

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Cerebral venous air embolism is a relatively rare condition that arises from iatrogenic or traumatic introduction of air into the venous system. We describe the ultrasonographic findings in a 1-day-old infant with iatrogenic retrograde cerebral venous air embolism, which to our knowledge, is the earliest case reported in the literature to date. This case highlights the role of cerebral ultrasonography in the detection and surveillance of cerebral venous air embolism in neonates.

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Retrograde cerebral venous air embolism: A rare cause of intracranial gas

Cited by 11 publications

References 6 publications

Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters

Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters

Retrograde Cerebral Air Embolism in a Patient with Intestinal Necrosis: A Case Report

Ultrasonographic detection of air in the superior sagittal sinus in a neonate with transposition of the great arteries

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