title: Presence of Gyriform Air Predicts Unfavorable Outcome in Venous Catheter-Related Cerebral Air Embolism.
abstract: BACKGROUND
  This study aimed to investigate the clinical predictors of unfavorable prognosis in patients with venous catheter-related cerebral air embolism.
  
  
  METHODS
  An extensive review of English literature was performed to obtain reports on cerebral air embolism published between January 1982 and July 2014 through PubMed, Journal at Ovid, and Web of Science using the Mesh terms and keywords "cerebral air embolism" and "cerebral gas embolism." Reports not fulfilling the diagnosis of cerebral air embolism and iterant articles were excluded. Demographics, clinical manifestations, and imaging findings were recorded. The air distribution on initial brain computed tomography (CT) was recorded as gyriform air (GF), cavernous sinus bubble, venous sinus bubble, and parenchymal and subarachnoid bubble. The enrolled subjects were further divided into favorable and unfavorable outcome groups for analyses.
  
  
  RESULTS
  Of the 33 cases enrolled, 31 had documented follow-up outcomes, including 14 with favorable and 17 with unfavorable prognoses. Patients with unfavorable outcome had older onset age (67.5 ± 15.8 versus 46.7 ± 17.0 years, P < .001), higher frequency of GF on brain CT (58.8% versus 0%, P < .01), initial consciousness disturbance (100% versus 42.9%, P < .001), and hemiparesis (100% versus 42.9%, P < .001), but lower frequency of cardiopulmonary symptoms (5.9% versus 64.3%, P < .01). In patients with central venous catheter-related cerebral air embolism, the retrograde mechanism had a tendency for worse outcomes (43.8% versus 0%, P = .023).
  
  
  CONCLUSIONS
  In patients with venous catheter-related cerebral air embolism, the presence of GF on brain CT imaging, old age, initial conscious disturbance, and hemiparesis may predict unfavorable outcomes.
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chih-Kuang
authors.initials: CK
authors.lastname: Cheng
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Chang
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Medical Education, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: ivanliu001@adm.cgmh.org.tw.
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Kuo-Lun
authors.initials: KL
authors.lastname: Huang
authors.affiliation: Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Shy-Chyi
authors.initials: SC
authors.lastname: Chin
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsiu-Chuan
authors.initials: HC
authors.lastname: Wu
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yeu-Jhy
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tsong-Hai
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003244:Consciousness Disorders / Q000209:etiology; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004618:Embolism, Air / Q000150:complications / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Cerebral air embolism; central venous catheter; gyriform air; outcome; venous catheter