title: Paradoxical cerebral air embolism occurred with postural change during rehabilitation, in a patient with ipsilateral internal carotid artery occlusion.
abstract: We report a 76-year-old man with paradoxical cerebral air embolism. He developed consciousness disturbance and left hemiparesis after a postural change in rehabilitation. CT showed multiple air densities within the right hemisphere. An echocardiography showed a large right-to-left (RL) shunt. We considered the reason to be that a small amount of air entered, and the Valsalva-like maneuver with the postural change moved air into arterial circulation through the RL shunt and embolized a brain artery. The present case showed that even a small amount of air in the venous circulation may become a potential risk for cerebral air embolism, especially in the presence of a large RL shunt.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Nippon Medical School Hospital, Japan. kentarow@nms.ac.jp
authors.forename: Kentaro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ueda
authors.forename: Arata
authors.initials: A
authors.lastname: Abe
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nishiyama
authors.forename: Seiji
authors.initials: S
authors.lastname: Okubo
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Katsura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Katayama
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology*; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000534:rehabilitation*; D004618:Embolism, Air / Q000175:diagnosis* / Q000209:etiology; D019320:Embolism, Paradoxical / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D011187:Posture