Two patients with paradoxical cerebral air embolism due to accidental disconnection of a subclavian intravenous catheter.
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Paradoxical cerebral air embolism is an unusual complication, usually associated with penetrating trauma to the thorax, percutaneous thin needle biopsy of the lungs, or decompression sickness. We report two patients with paradoxical cerebral air embolism complicating accidental disconnection of a sub-clavian intravenous catheter.<BR>Patient 1 was an 85-year-old man with tongue caner. He had been under hyperalimentation and developed dyspnea and became unresponsive to verbal stimulation after he tore off his subclavian intravenous catheter. He had repeated tonic convulsions and computerized tomographic (CT) scanning performed 2 hours lafter revealed multiple small, well defined air collections within the right frontal lobe. On magnetic resonance imaging (MRI) performed three days later, there were well defined areas of infarction scattered through the right frontal, and parietal lobes and the right basal ganglia. His condition deteriorated with complicating pneumonia and he died 2 months later. Autopsy disclosed that the foramen ovale was closed and there were no right-to-left shunts in either the heart or lungs. Patient 2 was a 76-year-old woman admitted for radiation therapy of malignant lymphoma. She had an alimentation catheter inserted and developed dyspnea, tachypnea and became unresponsive after she tore it off. CT scanning performed one hour later revealed multiple linear air collections, presumably located within small-caliber arteries, in the right frontal lobe. MRI taken next day showed infarction within the right frontal and parietal lobes.<BR>The mechanism of paradoxical cerebral air embolism is unclear, but the pathologic findings of our first patient suggest that air in the pulmonary circulation passes through a physiologically closed but anatomically patent arterior-venous small shunt within the lung. We also conclude that CT scanning provides the most direct method for confirming the diagnosis of cerebral air embolism and MRI is useful for the early discrimination of cerbral infarction areas.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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