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Decompression sickness and arterial gas embolism have nonspecific symptoms and are easily misdiagnosed if a recent patient history of diving and potential iatrogenic causes of AGE are not kept in mind. The authors review the pathophysiology, clinical features, and treatment of these disorders.

Cerebral air embolism infarction (CAEI) is a rare but life-threatening condition that can affect the venous or arterial blood supply to the brain. Its aetiology is mostly iatrogenic, often resulting from complications of cardiothoracic or neurosurgical procedures, as well as manipulations with peripheral or central catheters. If undiagnosed and untreated, cerebral air embolism infarction can lead to long-term neurological consequences or even death. Diagnosis relies on clinical presentation and neuroimaging findings from CT and MRI, which are time-sensitive and not well described in the current literature. We present a rare case of cerebral infarction as a complication of retrograde cerebral venous air embolism following haemodialysis catheter removal in a young patient, with management leading to a favourable outcome. The diagnosis was confirmed based on clinical manifestations and neuroimaging findings, with air emboli identified in the subarachnoid space on the CT scan, followed by characteristic MRI changes defined for cerebral air embolism infarcts. Timely diagnosis allowed for the rapid initiation of hyperbaric oxygen therapy and the rehabilitation process, resulting in positive outcomes. Timely neuroimaging-particularly CT within the first 2 hours-is critical for diagnosing CAEI. MRI findings, including cytotoxic and vasogenic oedema in a distal vascular distribution and leptomeningeal enhancement, further support diagnosis. Early identification and treatment initiation are essential for improving patient outcomes.

We describe a case of cerebral air embolism in a man with vascular Ehlers-Danlos syndrome. The key learning point is that cerebral air embolism can cause a florid encephalopathy and MR imaging appearance, yet the causative diagnosis may be made only by carefully scrutinising the CT scan, rather than the MRI. This patient was incorrectly diagnosed with posterior reversible encephalopathy syndrome before subsequent closer inspection of the CT scan at presentation disclosed the true diagnosis. Other diagnostic clues were the close temporal proximity to events that might introduce air into the systemic circulation (eg, thoracic procedures) or syndromes that predispose people to cerebral air embolism. The likely cause in this case was a transient bronchovenous fistula associated with vascular Ehlers-Danlos syndrome. Prompt identification of cerebral air embolism allows supportive measures to be started to prevent potentially fatal sequelae.

A 58-year-old woman with a history of catheter ablation for atrial fibrillation (AF) 3 weeks prior presented with right middle cerebral artery syndrome and a temperature of 38°C. Her National Institutes of Health Stroke Scale (NIHSS) was 23. [...]there were local inflammatory changes revealed by the presence of soft tissue infiltration centered on the latter structures. Corresponding author:

No patent foramen ovale was found, but a positive bubble test result suggested an underlying pulmonary venous shunt. Prognostic implications hinge on variables such as emboli dimensions, anatomical localization, and the expeditiousness of therapeutic intervention. [...]a prompt diagnosis and timely implementation of therapeutic measures are paramount given their potential to result in favorable clinical outcomes. Source of Support Open access funding provided by University of Zurich.

Background Arterial cerebral air embolism (CAE) is an uncommon but potentially catastrophic event. Patients can present with focal neurologic deficits, seizures, or coma. They may be treated with hyperbaric oxygen therapy. We review the causes, radiographic and clinical characteristics, and outcomes of patients with CAE. Methods We performed a retrospective chart review via an existing institutional database at Mayo Clinic to identify patients with arterial CAE. Demographic data, clinical characteristics, and diagnostic studies were extracted and classified on predefined criteria of diagnostic confidence, and descriptive and univariate analysis was completed. Results Fifteen patients met criteria for inclusion in our study. Most presented with focal deficits (80%) and/or coma (53%). Seven patients (47%) had seizures, including status epilepticus in one (7%). Five presented with increased muscle tone at the time of the event (33%). Computed tomography (CT) imaging was insensitive for the detection of CAE, only identifying free air in 4 of 13 who underwent this study. When obtained, magnetic resonance imaging typically showed multifocal areas of restricted diffusion. Six patients (40%) were treated with hyperbaric oxygen therapy. Age, Glasgow Coma Scale score at nadir, and use of hyperbaric oxygen therapy were not associated with functional outcome at 1 year in our cohort. Twenty-six percent of patients had a modified Rankin scale score of 0 one year after the event, and functional improvement over time was common after discharge. Conclusions A high index of clinical suspicion is needed to identify patients with CAE because of low sensitivity of free air on CT imaging and nonspecific clinical presentation. Acute alteration of consciousness, seizures, and focal signs occur frequently. Because improvement over time is possible even among patients with severe presentation, early prognostication should be approached with caution.

Computed tomography (CT)-guided percutaneous needle biopsy of the lung is a well-recognized and relatively safe diagnostic procedure for suspicious lung masses. Systemic air embolism (SAE) is a rare complication of transthoracic percutaneous lung biopsies. Herein, we present a case of an 81-year-old man who underwent CT-guided percutaneous needle biopsy of a suspicious nodule in the lower lobe of the right lung. Shortly after the procedure, the patient coughed up blood which prompted repeat CT imaging. He was found to have a massive cardiac air embolism. The patient became unresponsive and, despite resuscitation efforts, was pronounced dead. The pathophysiology, risk factors, clinical features, radiological evidence, and autopsy findings associated with SAE are discussed, which may, in light of the current literature, assist with the dilemma between assessing procedural complications and medical liability. Given the instances of SAE in the setting of long operative procedures despite careful technical execution, providing accurate and in-depth information, including procedure-related risks, even the rarest but potentially fatal ones, is recommended for informed consent to reduce medicolegal litigation issues.

We report the case of an 84-years old female patient who developed cerebral air embolism in association with the indwelling hemodialysis central venous catheter. Pneumocephalus, even though rare, should be included in the differential diagnosis of acute manifestation of neurologic deficits, especially in association with central venous access, surgical interventions or trauma, and requests prompt management. Brain computed tomography scanning remains the investigation of choice.