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Cheng CK, Chang TY, Liu CH, Chang CH, Huang KL, Chin SC, Wu HC, Chang YJ, Lee TH. Presence of Gyriform Air Predicts Unfavorable Outcome in Venous Catheter-Related Cerebral Air Embolism. J Stroke Cerebrovasc Dis 2015. [PMID: 26219843 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to investigate the clinical predictors of unfavorable prognosis in patients with venous catheter-related cerebral air embolism. METHODS An extensive review of English literature was performed to obtain reports on cerebral air embolism published between January 1982 and July 2014 through PubMed, Journal at Ovid, and Web of Science using the Mesh terms and keywords "cerebral air embolism" and "cerebral gas embolism." Reports not fulfilling the diagnosis of cerebral air embolism and iterant articles were excluded. Demographics, clinical manifestations, and imaging findings were recorded. The air distribution on initial brain computed tomography (CT) was recorded as gyriform air (GF), cavernous sinus bubble, venous sinus bubble, and parenchymal and subarachnoid bubble. The enrolled subjects were further divided into favorable and unfavorable outcome groups for analyses. RESULTS Of the 33 cases enrolled, 31 had documented follow-up outcomes, including 14 with favorable and 17 with unfavorable prognoses. Patients with unfavorable outcome had older onset age (67.5 ± 15.8 versus 46.7 ± 17.0 years, P < .001), higher frequency of GF on brain CT (58.8% versus 0%, P < .01), initial consciousness disturbance (100% versus 42.9%, P < .001), and hemiparesis (100% versus 42.9%, P < .001), but lower frequency of cardiopulmonary symptoms (5.9% versus 64.3%, P < .01). In patients with central venous catheter-related cerebral air embolism, the retrograde mechanism had a tendency for worse outcomes (43.8% versus 0%, P = .023). CONCLUSIONS In patients with venous catheter-related cerebral air embolism, the presence of GF on brain CT imaging, old age, initial conscious disturbance, and hemiparesis may predict unfavorable outcomes.
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Affiliation(s)
- Chih-Kuang Cheng
- Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Chang
- Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Hung Liu
- Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Medical Education, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chien-Hung Chang
- Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Lun Huang
- Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shy-Chyi Chin
- Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Chuan Wu
- Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeu-Jhy Chang
- Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Samaniego EA, Kim MA, Wijman CAC. Fatal massive cerebral air embolism in a lung transplant patient. Neurocrit Care 2011; 11:381-3. [PMID: 19649748 DOI: 10.1007/s12028-009-9257-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Massive air embolism has been described in multiple clinical scenarios, especially in critical ill patients who undergo invasive procedures. Nevertheless, air embolism is often unrecognized and a high index of suspicion is required to diagnose this entity. Two previous cases of air embolism in lung transplant patients have been described in the literature; we describe a third case of fatal massive air embolism and cardiovascular collapse in a lung transplant patient. METHODS Case report. RESULTS A 52-year-old woman who had a left lung transplant 18 months before admission presented with generalized convulsions and altered mental status. Forty-eight hours after admission and treatment of status epilepticus, she became severely hypotensive and her neurological status deteriorated to brain death. An electrocardiogram showed diffuse ST elevations and a non-contrast head computed tomography demonstrated intravascular air and cerebral edema. Inspection of her intravenous lines did not reveal any leakage or possible port of air entry. An autopsy did not reveal a source of air embolism. Although autopsy did not identify a source for air we suspect that the air originated from the transplanted lung. CONCLUSION This case underscores the potential severe consequences of air embolism and its systemic manifestations. A high index of suspicion for cerebral air embolism is warranted in lung transplant patients who present with neurological symptoms.
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Affiliation(s)
- Edgar A Samaniego
- Stanford Stroke Center, Stanford University Medical Center, 701 Welch Rd Ste 325, Bldg B, Palo Alto, CA 94304-1702, USA.
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Pandurangadu AV, Paul JAP, Barawi M, Irvin CB. A case report of cerebral air embolism after esophagogastroduodenoscopy: diagnosis and management in the emergency department. J Emerg Med 2011; 43:976-9. [PMID: 21236613 DOI: 10.1016/j.jemermed.2010.11.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 05/21/2010] [Accepted: 11/01/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Esophagogastroduodenoscopy (EGD) is a rare cause of cerebral air embolism (CAE). To our knowledge, there are only eight previously reported such cases in the history of the procedure. OBJECTIVE To identify clinical causes of CAE that can present to the emergency department (ED) and to understand the appropriate management of CAE. CASE REPORT A 71-year-old man presented with new-onset left-sided hemiparesis and dysarthria 2h after undergoing an outpatient EGD. The patient was diagnosed with CAE in the ED after undergoing a computed tomography scan of the brain without contrast. CONCLUSION The diagnosis of CAE is based on a thorough history and obtaining urgent radiographic imaging of the brain. The definitive treatment of CAE involves hyperbaric oxygen.
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Affiliation(s)
- Ananda V Pandurangadu
- Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, Michigan, USA
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Scruggs JE, Joffe A, Wood KE. Paradoxical air embolism successfully treated with hyperbaric oxygen. J Intensive Care Med 2008; 23:204-9. [PMID: 18403376 DOI: 10.1177/0885066607312865] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The use of the central venous catheter may be complicated by air embolism when central venous pressure is subatmospheric and the catheter is open to the surrounding air. Paradoxical air embolus occurs when the gas bubbles are able to traverse a right to left shunt, gaining access to the systemic arterial circulation causing ischemic symptoms in end organs. In this article, a case of a patient with an unknown patent foramen ovale through which air entered the arterial circulation resulting in obtundation and stroke after inadvertent manipulation of a Hickman catheter is presented. The physiology, clinical manifestations, and management strategies are also discussed.
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Affiliation(s)
- Jesse E Scruggs
- Section of Pulmonary/Critical Care Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792, USA
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