title: Spontaneous cerebral gas embolism and pulmonary arteriovenous malformation: a case report.
abstract: Pulmonary barotrauma can cause cerebral arterial gas embolism (CAGE) from pulmonary overdistension of alveoli forcing gas into the pulmonary vasculature. We report a case of CAGE in a man found to have occult pulmonary arteriovenous malformation (PAVM) and undiagnosed obstructive sleep apnea (OSA). A 46-year-old man was admitted to the hospital for an acute seizure and left-sided weakness, with telangiectasias on his lower lip and tongue. Brain-computed tomography (CT) showed gas emboli in the right hemisphere. Chest CT revealed a 1.8-cm PAVM in the posterior right costophrenic sulcus. A transthoracic echocardiogram showed no intracardiac shunt or patent foramen ovale. He was treated with phenytoin, lidocaine and hyperbaric oxygen. The PAVM was occluded with a detachable balloon followed by coil embolization. Polysomnography revealed severe obstructive sleep apnea, which was treated with CPAP. Seven years later, the patient was functioning at his pre-event baseline. We propose the CAGE was caused by high negative intrathoracic pressures while breathing against an obstructed upper airway, with air entrainment into the PAVM and subsequent arterialization.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Harlan
authors.forename: Laura H
authors.initials: LH
authors.lastname: Davies
authors.forename: Lindell K
authors.initials: LK
authors.lastname: Weaver
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Cloward
authors.forename: Susan
authors.initials: S
authors.lastname: Churchill
authors.forename: Kayla
authors.initials: K
authors.lastname: Deru
authors.forename: Lisa
authors.initials: L
authors.lastname: Yanase
mesh_terms: D001165:Arteriovenous Malformations / Q000150:complications* / Q000628:therapy; D004618:Embolism, Air / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D020766:Intracranial Embolism / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities*; D011667:Pulmonary Veins / Q000002:abnormalities*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis