Cerebral air embolism is rare but can be fatal. They may be venous or arterial and are often iatrogenic in cause.
Presentation is often varied and non-specific but include confusion, motor weakness, decreased consciousness, seizure and vision loss.
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.
- 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
- may only be diagnostic in the acute setting as gas is absorbed rapidly 4
- 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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