Seizures in Iatrogenic Cerebral Arterial Gas Embolism

Muller, Fenna F; Hulst, Rob A. van; Coutinho, Jonathan M.; Weenink, Robert P.

doi:10.1097/cce.0000000000000513

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…[ 18 ] By integrating various therapeutic modalities – physical therapy, occupational therapy, speech and language therapy, and psychological support – EIRT aims to provide a comprehensive, patient-centered care plan. [ 19 ] This integrated approach ensures that the multifaceted needs of each patient are met, promoting better overall outcomes and enhancing quality of life. As healthcare professionals and researchers continue to seek optimal strategies for poststroke recovery, understanding and harnessing the potential of EIRT becomes increasingly important.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of early integrated rehabilitation therapy on treatment outcomes and limb functional recovery in patients with cerebral embolism: An observational study

Ban,

Qing,

Teng

et al. 2024

Medicine

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Cerebral embolism presents a significant challenge for recovery of motor and neurological function. Early integrated rehabilitation therapy (EIRT) has been proposed as a beneficial approach, yet its efficacy requires thorough evaluation. This retrospective study, conducted from January 2020 to January 2023, involved 117 patient’s post-cerebral embolism, divided into an EIRT group (n = 56) receiving EIRT and a control group (n = 61) receiving standard care. The Fugl-Meyer Assessment (FMA) and the National Institutes of Health Stroke Scale (NIHSS) were used to evaluate motor and neurological functions, while muscle strength was categorized from Level 0 (complete paralysis) to Level V (normal strength) to assess physical recovery. Eligibility centered on confirmed cerebral embolism diagnosis, timing of poststroke admission, and baseline functional status. The study adhered to strict ethical standards, with informed consent obtained from all participants. The EIRT group showed substantial improvements in both FMA and NIHSS scores compared to the control group, indicating better motor and neurological recovery. Significant differences were found in the posttreatment FMA (P < .01) and NIHSS scores (P < .01). Muscle strength analysis further confirmed the positive impact of EIRT with more patients in the EIRT group achieving higher levels of muscle strength at discharge. The study demonstrates the potential of EIRT to significantly improve motor and neurological outcomes for patient’s post-cerebral embolism. The marked improvements in the observation group suggest that EIRT should be considered for broader application in stroke rehabilitation to enhance recovery and improve quality of life.

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Section: Discussionmentioning

confidence: 99%

Efficacy of early integrated rehabilitation therapy on treatment outcomes and limb functional recovery in patients with cerebral embolism: An observational study

Ban,

Qing,

Teng

et al. 2024

Medicine

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“…Although PLEDS and FIRDA were not clearly noted in the EEG of the present patient, these findings may be consistent with those of early seizure in ischemic stroke. Interestingly, while an analysis of 35 studies on the incidence of seizures after ischemic stroke reported early seizure (either 1 or 2 weeks following stroke) occurrence in 3.3% of cases [ 12 ], the incidence of seizures after CAE due to “invasive iatrogenic mechanism” ranges between 24% and 73% [ 8 , 13 , 14 ], indicating greater frequency of early seizures after CAE than after ischemic stroke [ 14 ]. Therefore, seizures associated with CAE may involve unique mechanisms, such as an inflammatory response triggered by the bubble surface [ 15 ] or the direct effects of an air embolus on the central nervous system, apart from processes leading to early seizure in patients with ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to early seizures in ischemic stroke, recurrences of convulsive seizures after CAE may be relatively rare [ 14 ], even though the conditions that can cause CAE are often serious. Possible explanations for the low rate of recurrence of convulsive seizures in CAE include properties of air emboli that change over time, absence of gliosis typically observed with late seizures in ischemic stroke, and the availability of anticonvulsants.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalographic findings after convulsive seizures due to cerebral arterial air embolism secondary to lung cancer: a case report

et al. 2022

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Background Cerebral arterial air embolism is often associated with an invasive iatrogenic etiology and a high rate of convulsive seizures. There are only a few descriptions of electroencephalogram findings in convulsive seizures due to cerebral arterial air embolism of noniatrogenic etiology. Herein, we describe the case of a patient with lung cancer and convulsive seizures with abnormalities detected on electroencephalogram caused by cerebral arterial air embolism of noniatrogenic etiology. Case presentation A 55-year-old Japanese man underwent radiotherapy and chemotherapy for cancer in the hilum of the left lung that was diagnosed after hemoptysis. One year after the diagnosis, he developed fever and chest pain that required hospitalization. At admission, he was in shock, and chest computed tomography revealed invasion of the left atrium and left main bronchus by the hilar cancer. Chest and abdominal computed tomography revealed small low-density areas within the tumor and around the intestinal membrane, which were interpreted as the presence of air due to invasion of the lung cancer. He was diagnosed with septic shock due to necrotic infection secondary to cancer invasion into the left atrium. The following day, he complained of difficulty in speaking and weakness in the left side of his body. A head computed tomography scan revealed multiple small low-density areas in the right cortex and bilateral subcortex, which were interpreted as air emboli. On day 3, he experienced generalized tonic–clonic seizures for approximately 1 minute, followed by myoclonus-like convulsions in the left lower limb and a right-sided gaze. The electroencephalogram findings after the convulsive seizures revealed partial epilepsy-like waves with intermittent spikes in the bilateral cerebral hemispheres and a diffuse slow wave in the left frontal lobe. He recovered from sepsis without recurrence of convulsive seizures; however, he died of hemoptysis on day 50 after discharge. Conclusions Electroencephalogram findings of focal spike activities and diffuse slow waves were detected in early seizures due to cerebral arterial air embolism of noniatrogenic etiology associated with lung cancer. Additional case descriptions are warranted to establish patterns in electroencephalogram findings specific to cerebral arterial air embolism.

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Early hyperbaric oxygen therapy is associated with favorable outcome in patients with iatrogenic cerebral arterial gas embolism: systematic review and individual patient data meta-analysis of observational studies

Fakkert,

Karlas,

Schober

et al. 2023

Crit Care

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Background Iatrogenic cerebral arterial gas embolism (CAGE) caused by invasive medical procedures may be treated with hyperbaric oxygen therapy (HBOT). Previous studies suggested that initiation of HBOT within 6–8 h is associated with higher probability of favorable outcome, when compared to time-to-HBOT beyond 8 h. We performed a group level and individual patient level meta-analysis of observational studies, to evaluate the relationship between time-to-HBOT and outcome after iatrogenic CAGE. Methods We systematically searched for studies reporting on time-to-HBOT and outcome in patients with iatrogenic CAGE. On group level, we meta-analyzed the differences between median time-to-HBOT in patients with favorable versus unfavorable outcome. On individual patient level, we analyzed the relationship between time-to-HBOT and probability of favorable outcome in a generalized linear mixed effects model. Results Group level meta-analysis (ten studies, 263 patients) shows that patients with favorable outcome were treated with HBOT 2.4 h (95% CI 0.6–9.7) earlier than patients with unfavorable outcome. The generalized linear mixed effects model (eight studies, 126 patients) shows a significant relationship between time-to-HBOT and probability of favorable outcome (p = 0.013) that remains significant after correcting for severity of manifestations (p = 0.041). Probability of favorable outcome decreases from approximately 65% when HBOT is started immediately, to 30% when HBOT is delayed for 15 h. Conclusions Increased time-to-HBOT is associated with decreased probability of favorable outcome in iatrogenic CAGE. This suggests that early initiation of HBOT in iatrogenic CAGE is of vital importance.

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Seizures in Iatrogenic Cerebral Arterial Gas Embolism

Abstract: Supplemental Digital Content is available in the text.

Cited by 3 publications

References 11 publications

Efficacy of early integrated rehabilitation therapy on treatment outcomes and limb functional recovery in patients with cerebral embolism: An observational study

Efficacy of early integrated rehabilitation therapy on treatment outcomes and limb functional recovery in patients with cerebral embolism: An observational study

Electroencephalographic findings after convulsive seizures due to cerebral arterial air embolism secondary to lung cancer: a case report

Early hyperbaric oxygen therapy is associated with favorable outcome in patients with iatrogenic cerebral arterial gas embolism: systematic review and individual patient data meta-analysis of observational studies

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