Journal Article

Clinical Characteristics, Imaging Findings, and Outcomes of Cerebral Air Embolism

Braksick, Sherri A., Rabinstein, Alejandro A., Brown, Andrew E.

2023

Overview

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.

• Publisher: Springer US,Springer Nature B.V
• Subject: Cardiac arrest / Catheters / Classification / Coma - therapy / Critical Care Medicine / Electroencephalography / Embolism, Air - diagnostic imaging / Embolism, Air - etiology / Embolism, Air - therapy / Embolisms / Embolization / Esophagus / Females / Fistula / Glasgow Coma Scale / Humans / Hyperbaric Oxygenation - adverse effects / Iatrogenesis / Intensive / Internal Medicine / Magnetic resonance imaging / Medical imaging / Medicine / Medicine & Public Health / Neuroimaging / Neurology / Neurosurgery / Original Work / Oxygen therapy / Patients / Retrospective Studies / Seizures - etiology / Seizures - therapy / Thoracic surgery / Tomography / Tomography, X-Ray Computed / Veins & arteries / Watersheds