title: Cerebral air embolism after pleural streptokinase instillation.
abstract: Iatrogenic pulmonary barotrauma and cerebral arterial gas embolism (CAGE) may complicate a variety of medical procedures, such as certain types of surgery, drug administration through thoracic drainage, pneumoperitoneum, cystoscopy, bronchoscopy, etc. Hyperbaric oxygen treatment following the guidelines for CAGE in diving is the treatment of choice. Pleural streptokinase instillation is a common treatment for parapneumonic pleural effusion and may lead to CAGE. We present such a complication in a 79-year-old woman with a left-sided empyema. Neurological recovery was reasonable, but a left hemiparesis persisted. Prompt treatment of CAGE is necessary to avoid permanent injury and severe disability.
authors: Euregio Centre for Hyperbaric Oxygenation, Aachen, Department of Surgical Intensive and Intermediate Care Medicine RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany, Fax: +49-(0)241-80-338-04-44, E-mail: tjanisch@ukaachen.de.
authors: Thorsten
authors: T
authors: Janisch
authors: Euregio Centre for Hyperbaric Oxygenation, Department for Anesthesiology, RWTH Aachen University Hospital, Germany.
authors: Ullrich
authors: U
authors: Siekmann
authors: Department of Surgical Intensive and Intermediate Care Medicine RWTH Aachen University Hospital, Aachen, Germany.
authors: Rüdger
authors: R
authors: Kopp
mesh_terms: D000368:Aged; D015505:Chest Tubes; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology*; D016724:Empyema, Pleural / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D035422:Pleural Cavity; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography; D013300:Streptokinase / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase
keywords: Pulmonary barotrauma; case reports; cerebral arterial gas embolism (CAGE); hyperbaric oxygen therapy