Cerebral air embolism is rare but can be fatal. They may be venous or aterial 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 of 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 absorped 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.
- 1. Sviri S, Woods WP, van Heerden PV. Air embolism-a case series and review. Crit Care Resusc. 2006;6 (4): 271-6. Pubmed citation
- 2. Emergency Radiology: Imaging of Acute Pathologies. Springer. ISBN:1441995919. Read it at Google Books - Find it at Amazon
- 3. Lempel JK, Jozwik B, Manfredi C et-al. Cerebral air embolism: a result of atrioesophageal fistula. AJNR Am J Neuroradiol. 2012;33 (3): E40-1. doi:10.3174/ajnr.A3001 - Pubmed citation
- 4. Caulfield AF, Lansberg MG, Marks MP et-al. MRI characteristics of cerebral air embolism from a venous source. Neurology. 2006;66 (6): 945-6. doi:10.1212/01.wnl.0000203117.20406.eb - Pubmed citation
- 5. Emby DJ, Ho K. Air embolus revisited: a diagnostic and interventional radiological perspective—bubble trouble and the dynamic Mercedes Benz sign. S Afr J Radiol 2006; 10:3-7