title: Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration.
abstract: Cerebral air embolism is a dreaded complication of invasive medical procedures. The mainstay of therapy for patients with cerebral air embolism has been hyperbaric oxygen therapy, high flow oxygen therapy, and anticonvulsants. We present a novel therapeutic approach for treatment of cerebral air embolism causing large vessel occlusion, using endovascular aspiration. Our patient developed a cerebral air embolism following sclerotherapy for varicose veins. This caused near total occlusion of the superior division of the M2 segment of the right middle cerebral artery. Symptoms included unilateral paralysis, unintelligible speech, and hemianopia; National Institutes of Health Stroke Scale (NIHSS) on presentation was 16. The air embolism was treated using a distal aspiration technique. Angiography following aspiration showed Thrombolysis in Cerebral Infarction 2B reperfusion. Following aspiration, the patient was re-examined; NIHSS at that time was 4. At 1 month follow-up, the modified Rankin Scale score was 1 and NIHSS was 1. Treatment of cerebral air embolism is discussed.
authors.affiliation: Division of Neurosurgery, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Belton
authors.affiliation: SSM Health Medical Group, Fenton, Missouri, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Department of Neurology, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA.
authors.forename: Syeda L
authors.initials: SL
authors.lastname: Alqadri
authors.affiliation: Department of Neurology, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA.
authors.forename: Gurpreet S
authors.initials: GS
authors.lastname: Khakh
authors.affiliation: Department of Neurology, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA.
authors.forename: Premkumar Nattanmai
authors.initials: PN
authors.lastname: Chandrasekaran
authors.affiliation: Department of Neurology, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Newey
authors.affiliation: Division of Neurosurgery, University of Missouri Columbia School of Medicine, Columbia, Missouri, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Humphries
mesh_terms: D000368:Aged; D004618:Embolism, Air / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008297:Male; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Angiography; Embolic; Stroke; Thrombectomy