cerebral air embolism
Therapeutic
hypothermia in cerebral air embolism: a case report. CT and MRI in cerebral air embolism. The initial head CT shows air entrapment in cortical branches of both middle cerebral arteries and in the cavernous sinus (arrows in A and B). On day ten MRI of the brain demonstrates cortically localized areas of restricted diffusion along the gyri ( arrows in C and D).
Cerebral air
embolism via port catheter and endoscopic retrograde cholangio-pancreatography. CT in cerebral air embolism via port catheter. Panel A, native axial CT-scan of the brain shows inclusion of air (arrow) within the subarachnoidal spaces more prominent in the right hemisphere. Panel B, CT-thorax shows air in the port catheter (arrow) which is used for parenteral nutrition under home care conditions.
Cerebral air
embolism via port catheter and endoscopic retrograde cholangio-pancreatography. CT in cerebral air embolism via ERCP. Panel A, native axial CT-scan of the brain shows a small amount of air accumulation in the right posterior subarachnoidal space (arrow) and in the superior sagittal venous sinus (arrow). Panel B, native axial CT-scan of the brain two days later shows severe infarction (arrow) predominantly in the right posterior hemisphere with malignant brain swelling.
Enhancing
vigilance for cerebral air embolism after pneumonectomy: a case report. Multiple free air can be seen in the blood vessels of bilateral frontal sulcus as indicated by the arrows
Enhancing
vigilance for cerebral air embolism after pneumonectomy: a case report. Dispersed free air was seen in the vessels of the right occipital lobe and suspicious cerebral infarction lesions were seen
Multiple
small hemorrhagic infarcts in cerebral air embolism: a case report. Brain CT and MRI of case 1. a Brain CT shows numerous foci of intravascular air within the area supplied by bilateral anterior cerebral arteries (ACAs) and the right middle cerebral artery (MCA). b Diffusion-weighted imaging (DWI) and d fluid attenuated inversion recovery (FLAIR) images show high-intensity areas that are supplied by the bilateral anterior cerebral arteries and the right middle cerebral artery. c Hypointense signal was observed on the apparent diffusion coefficient (ADC) map. e T2 star-weighted imaging (T2*WI) shows many hypointense spots in the area perfused by the bilateral anterior cerebral arteries and the right middle cerebral artery
Multiple
small hemorrhagic infarcts in cerebral air embolism: a case report. Brain CT and MRI of case 2. a Brain CT on admission shows a low-density spot in the right frontal lobe (red arrow) and old infarction (red arrowhead). b diffusion-weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) images showed old infarction (red arrowhead), did not show obvious signals corresponding to the low-density spot on brain CT. c T2 star-weighted imaging (T2*WI) of MRI of case 2 on admission shows many hypointense signals in bilateral frontoparietal lobes. d T2 star-weighted imaging at 78 days after onset shows that the distribution of signals did not change compared with T2 star-weighted imaging on the admission day
Cerebral air embolism is rare but can be fatal. They may be venous or arterial and are often iatrogenic in cause.
Clinical presentation
Presentation is often varied and non-specific but include confusion, motor weakness, decreased consciousness, seizure and vision loss.
Pathology
Cerebral air embolism can be within the arterial or venous systems. Air can enter both systems directly or cause paradoxical embolus with a venous air embolus entering the arterial system via a right-to-left shunt.
Etiology
- arterial: trauma, surgery (especially cardiothoracic/neurosurgery), procedures (e.g. arterial line, lung biopsy)
- venous: central venous catheter placement/removal; IV contrast injection into peripheral line
Complications
Cerebral air emboli can act like thrombotic emobli and cause end-artery occlusion and ischemic stroke. Cerebral edema can also develop.
Radiographic features
CT
- may only be diagnostic in the acute setting as gas is absorbed rapidly
- use of lung windows may help increase detection
Treatment and prognosis
Treatment is typically supportive although there is increasing evidence for the use of hyperbaric oxygen therapy.
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Assoziationen und Differentialdiagnosen zu zerebrale Luftembolie:
