Presentation
Decline in consciousness. History of ischemic stroke 4 days ago. History of severe malnutrition with placement of parenteral nutrition.
Patient Data
Persistence of a hypodense, cortico-subcortical area in the right frontal territory in relation to acute perfusional disorder. It is noteworthy the presence of air bubbles in that area that could correspond to gas embolisms.
Hypodense, cortico-subcortical area in the right frontal territory in relation to acute perfusional disorder.
Annotated non-contrast brain CT showing air bubbles in vascular territories.
Case Discussion
Vascular air embolism, a rare event associated with medical-surgical procedures, has shown an increasing incidence in recent years.
Misdiagnoses are common, and the condition, linked with CVC management and neurosurgical procedures, involves a negative pressure gradient allowing atmospheric air into the vascular system.
Cerebral arterial gas embolism (CAE) may occur in the absence of a documented right-left shunt, potentially due to retrograde venous movement.
Morbidity and mortality in vascular gas embolism depend on factors like gas volume, accumulation rate, and patient position. CAE's neurological manifestations, often clinically silent, vary widely.
Early detection through urgent CT scans, preferably within the first hour, is critical. Non-contrast CT scans are highly sensitive, revealing air emboli in cerebral vessels.
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