title: Intracerebral hemorrhage related to systemic gas embolism during hysteroscopy.
abstract: Iatrogenic gas embolism is a rare but serious problem that has been documented in almost all medical specialties including gynecology. We present a 49-year-old woman undergoing operative hysteroscopy and myomectomy, who sustained sudden hypotension and decrease in the end-tidal carbon dioxid levels during the procedure. Systemic gas embolism was confirmed by echocardiographic evidence of bubbles in both right and left cardiac cavities and a rise of troponin. Hyperbaric oxygen was rapidly administered in addition to maintenance of vital functions and anti-thrombotic prevention with calciparin. A right hemiparesis was apparent after recovery from general anesthesia. Brain-computed tomography and magnetic resonnance imaging, performed on Days 3 and 2 respectively, showed a left fronto-parietal hematoma surrounded by edema. Having ruled out risk factors for a primary ischemic or hemorrhagic stroke, we concluded that hemorragic transformation of the ischemic cerebral lesion caused by gas embolism was responsible for the observed intraparenchymal hematoma. As far as we know, this is the first report relating cerebral gas embolism with an intracerebral hemorrhage. It provides an argument against anticoagulant therapy during the early stages of gas embolism care.
authors.affiliation: CHU Brest, Pôle Anesthesiology Intensive Care SAMU, Department of Anesthesiology and Intensive Care, Center for Hyperbaric Medicine, Brest, F-29200 France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Guillard
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Nancy
authors.forename: Hervé
authors.initials: H
authors.lastname: Floch
authors.forename: Anne
authors.initials: A
authors.lastname: Henckes
authors.forename: Guy
authors.initials: G
authors.lastname: Cochard
authors.forename: Josiane
authors.initials: J
authors.lastname: Arvieux
authors.forename: Charles Christian
authors.initials: CC
authors.lastname: Arvieux
mesh_terms: D015415:Biomarkers / Q000097:blood; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D004618:Embolism, Air / Q000150:complications* / Q000628:therapy; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D007022:Hypotension / Q000209:etiology; D015907:Hysteroscopy / Q000009:adverse effects*; D007431:Intraoperative Complications / Q000209:etiology; D008875:Middle Aged; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin