Santucci Joshua, Mullaguri Naresh, Battineni Anusha, Guddeti Raviteja R, Newey Christopher R
Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Division of Neurology, Department of Medicine, Prisma Health Upstate, University of South Carolina Greenville School of Medicine, Greenville, SC, USA.
Case Rep Neurol Med. 2021 Oct 5;2021:1063264. doi: 10.1155/2021/1063264. eCollection 2021.
Cerebral air embolism is a rare, yet serious neurological occurrence with unclear incidence and prevalence. Here, we present a case of fatal cerebral arterial and venous cerebral gas embolism in a patient with infective endocarditis and known large right-to-left shunt and severe tricuspid regurgitation following pressurized fluid bolus administration. . A 32-year-old female was admitted to the medical intensive care unit from a long-term acute care facility with acute on chronic respiratory failure. Her medical history was significant for intravenous heroin and cocaine abuse, methicillin-sensitive tricuspid valve infective endocarditis on vancomycin, patent foramen ovale, septic pulmonary embolism with cavitation, tracheostomy with chronic ventilator dependence, multifocal cerebral infarction, hepatitis C, nephrolithiasis, anxiety, and depression. After intravenous fluid administration, she became unresponsive with roving gaze, sluggish pupils, and hypotensive requiring vasopressors. CT of the brain showed diffuse arterial and venous cerebral air embolism secondary to accidental air administration from fluid bolus. Magnetic resonance imaging of the brain showed diffuse global anoxic injury and flattening of the globe at the optic nerve insertion. Given poor prognosis, her family chose comfort measures and she died.
Fatal cerebral air embolism can occur through peripheral intravenous routes when the lines are inadequately primed and fluids administered with pressure. Caution must be exercised in patients with right-to-left shunting as air may gain access to systemic circulation.
脑空气栓塞是一种罕见但严重的神经系统疾病，其发病率和患病率尚不清楚。在此，我们报告一例患有感染性心内膜炎、已知存在大量右向左分流和严重三尖瓣反流的患者，在加压推注液体后发生致命性脑动脉和静脉气体栓塞的病例。一名32岁女性从长期急性护理机构转入医学重症监护病房，患有慢性呼吸衰竭急性加重。她的病史包括静脉注射海洛因和可卡因成瘾、万古霉素治疗的甲氧西林敏感型三尖瓣感染性心内膜炎、卵圆孔未闭、伴有空洞形成的感染性肺栓塞、依赖慢性呼吸机的气管切开术、多灶性脑梗死、丙型肝炎、肾结石、焦虑症和抑郁症。静脉输液后，她出现无反应，目光游动，瞳孔迟钝，血压降低，需要使用血管升压药。脑部CT显示因推注液体意外注入空气导致弥漫性脑动脉和静脉空气栓塞。脑部磁共振成像显示弥漫性全脑缺氧损伤以及视神经插入处眼球变平。鉴于预后不良，她的家人选择了姑息治疗措施，随后她去世。
当输液管路未充分排气且加压输液时，致命性脑空气栓塞可通过外周静脉途径发生。对于存在右向左分流的患者必须谨慎，因为空气可能进入体循环。
