Massive Paradoxical Air Embolism in Brain Occurring after Central Venous Catheterization: A Case Report

Abstract

Cerebral air embolism is a rare but fatal complication of central venous catheterization. Here, we report a case of paradoxical cerebral air embolism associated with central venous catheterization. An 85-yr-old man underwent right internal jugular vein catheterization, and became obtunded. Brain MR imaging and CT revealed acute infarction with multiple air bubbles on the side of catheter insertion. The possibility of cerebral air embolism should be considered in patients developing neurological impairment after central venous catheterization, and efforts should be made to limit cerebral damage.

Nonaccidental Arterial Cerebral Air Embolism: A Ten-Year Stroke Center Experience

“…Other reported frequencies are 0.1-2% with the use of central catheters [2] and 0.06% with the use of microbubbles in echocardiography [3]. Like others, we cannot exclude an underascertainment due to possible missed diagnosis.…”

“…Most nonaccidental causes of arterial CAE are iatrogenic and related to microbubble studies [3], manipulations of a CVC [2,7] or surgery. Causes in our patients were often related to right-to-left shunt.…”

“…Paradoxical air embolism through the PFO was also the likely cause in our patient with a CAE shortly after starting hemodialysis through a CVC. This may be prevented by avoiding deep inspiration and by using the Trendelenburg position, all of which may prevent air aspiration into the CVC [2]. …”

“…It is a medical emergency as it can lead to cerebral ischemic events (CIE) such as ischemic stroke or transient ischemic attack (TIA), or to acute coronary syndrome. The incidence of cerebral air embolism (CAE) in a stroke population remains unknown [2,3,4,5]. …”

Iatrogenic cerebral arterial and venous gas embolism leading to massive hemorrhage, herniation, and death

“…2 CGE has been shown to occur in the setting of lung transplant, 3 transbronchial lung biopsy, 4 central venous catheterization, 5 coronary artery byass, 6 and flexible bronchoscopy, 4,6 among others. The diagnosis is based on classic strokelike symptoms after a precipitating event and brain imaging.…”