title: Cerebral gas embolism associated with central venous catheter: Systematic review.
abstract: OBJECTIVE
  Cerebral gas embolism (CGE) is a potentially catastrophic complication of central venous catheters (CVCs) manipulation or accidental disconnection, which is rarely reported in the literature. This systematic review aims to characterize the clinical manifestations, imaging features and outcome of CGE associated with CVCs.
  
  
  METHODS
  Systematic literature search of all published cases of CGE associated with CVCs, and identification of previously unreported local cases. Descriptive analysis of all cases, mortality analysis for cases with individualized data.
  
  
  RESULTS
  Of the 158 patients with CGE associated with CVCs found, 71.8% were male and mean age was 56.4years. CGE symptoms frequently occurred while in the upright position. The most frequent neurological manifestation was sudden-onset focal neurological sign (67.7%), followed by coma (59.5%), epileptic seizures (24.7%) and encephalopathy (21.5%). Imaging revealed intracranial air bubbles in 69.1% and cerebral ischemia or edema was demonstrated in 66.7%. Overall mortality was 21.7%, and clinical predictors of mortality were increasing age (p<0.001), coma (p=0.001), cardiorespiratory arrest shortly after symptom onset (p<0.001) and male sex (p=0.035).
  
  
  CONCLUSIONS
  CGE associated with CVCs may mimic ischemic stroke, but patients frequently present a severe vigilance disturbance and epileptic seizures. Mortality occurs in 1/5 of patients, which substantiates implementation of protocols and measures to prevent this severe complication of CVC use.
authors.affiliation: Neurology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal. Electronic address: Joao.Pinho@hospitaldebraga.pt.
authors.forename: João
authors.initials: J
authors.lastname: Pinho
authors.affiliation: Neuroradiology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal. Electronic address: josemvamorim@gmail.com.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Amorim
authors.affiliation: Neurology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal. Electronic address: josedearaujo88@gmail.com.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Araújo
authors.affiliation: Internal Medicine Department, Hospital Conde de Bertiandos, Rua Conde de Bertiandos, 4990-041 Ponte de Lima, Portugal. Electronic address: helenvilaca@gmail.com.
authors.forename: Helena
authors.initials: H
authors.lastname: Vilaça
authors.affiliation: Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia, R. Dr. Francisco Sá Carneiro, 4400-129 Vila Nova de Gaia, Portugal. Electronic address: mqribeiro@gmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ribeiro
authors.affiliation: Neurology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal. Electronic address: joaocampospereira@sapo.pt.
authors.forename: João
authors.initials: J
authors.lastname: Pereira
authors.affiliation: Neurology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal. Electronic address: carla.m.c.ferreira@gmail.com.
authors.forename: Carla
authors.initials: C
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D062905:Central Venous Catheters / Q000009:adverse effects*; D004618:Embolism, Air / Q000150:complications / Q000209:etiology*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D039781:PubMed
keywords: Central Venous Catheters; Embolism Gas; Mortality; Neuroimaging; Prognosis; Stroke