Acute and subacute neurovascular impact of cryptogenic air emboli.

Autor:	Gummerson CE; Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States., Parasram M; Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States., Peng TJ; Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States., Picard JM; Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States., Kahn PA; Pulmonary and Critical Care Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States., Angelus E; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States., Bhatt S; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States., de Havenon A; Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States., Jasne AS; Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States., Magid-Bernstein J; Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States.
Jazyk:	angličtina
Zdroj:	Surgical neurology international [Surg Neurol Int] 2023 Aug 11; Vol. 14, pp. 285. Date of Electronic Publication: 2023 Aug 11 (Print Publication: 2023).
DOI:	10.25259/SNI_382_2023
Abstrakt:	Background: Cerebral air embolism is a rare cause of acute ischemic stroke that is becoming increasingly well-described in the literature. However, the mechanism and severity of this type of injury can vary, with ischemia typically emerging early in the course of care. To the best of our knowledge, delayed ischemia in this setting has not yet been described. Case Description: A stroke code was called for an unresponsive, hospitalized, 75-year-old man. A computerized tomography (CT) scan of the head revealed air within the right greater than left hemispheric cortical veins with loss of sulcation, concerning for developing ischemia, and CT angiography revealed absent opacification of the distal cortical vessels in the right anterior cerebral artery and middle cerebral artery territories. Magnetic resonance imaging (MRI) of the brain was obtained 5.75 h after the patient's last known well-showed small areas of subtle cortical diffusion restriction. Follow-up CT head within 24 h showed near-complete resolution of the air emboli after treatment with 100% fraction of inspired oxygen on mechanical ventilation. Subsequent MRI, performed 4 days after the initial event, showed extensive cortical diffusion restriction and cerebral edema crossing vascular territories. Conclusion: This case highlights that cerebral air emboli can cause delayed ischemia that may not be appreciated on initial imaging. As such, affected patients may require intensive neurocritical care management, close neurologic monitoring, and repeat imaging irrespective of initial radiographic findings. Competing Interests: There are no conflicts of interest. (Copyright: © 2023 Surgical Neurology International.)
Databáze:	MEDLINE
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