Cerebral air embolism

Last revised by Calum Worsley on 08 Dec 2021

Cerebral air embolism is rare but can be fatal. They may be venous or arterial and are often iatrogenic

Presentation is often varied and non-specific but include confusion, motor weakness, decreased consciousness, seizure and loss of vision. 

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

Cerebral air/gas emboli can act like thrombotic emboli and cause end-artery occlusion and ischemic stroke. Cerebral edema can also develop. 

The distribution of gas is variable and extensive cerebral infarction, often in a watershed distribution, maybe the only visible change. 

  • may only be diagnostic in the acute setting as gas is absorbed rapidly 4
  • use of lung windows may help increase detection

MRI is primarily used to evaluate the complications of cerebral air embolism (infarction) rather than to detect the air directly. 

Treatment is typically supportive although there is increasing evidence for the use of hyperbaric oxygen therapy

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Cases and figures

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