Bousbaa Amine, Renou Marianne, Poulain Coralie, Laurent Pierre, El Esper Najeh, Choukroun Gabriel, Caillard Pauline
Department of Nephrology, Amiens University Hospital, University of Picardie Jules Verne, 1 rond-point du Professeur Christian Cabrol, F-80054 Amiens, France.
Department of Nephrology, Dialysis, and Transplantation, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France.
Ther Adv Neurol Disord. 2024 Oct 9;17:17562864241287457. doi: 10.1177/17562864241287457. eCollection 2024.
We describe here the first case of cerebral air embolism (CAE) due to a dysfunctional long-term central venous catheter for hemodialysis in a 39-year-old woman with a history of lung transplantation. Air emboli are rare but potentially fatal complications of hemodialysis, in particular, when they involve the brain. Early management with hyperbaric oxygen therapy (HBOT) is critical to prevent deterioration of the patient's condition. In this case, our patient presented her first symptoms, likely a seizure due to multiple cerebral air emboli, during her hemodialysis session. She was then monitored in the Nephrology Intensive Care Unit in accordance to the medical reference center (with HBOT). Twelve hours later, she experienced secondary deterioration, presenting with acute aphasia, left hemineglect syndrome, and hemiplegia. She was rapidly transferred to the medical reference center for HBOT. The patient fully recovered after receiving three sessions of HBOT. She also presented a seizure during each HBOT session, attributed to hyperoxia. She never experienced another seizure after the episode of CAE. This case highlights the importance of considering patients who have a lung transplant to be at increased risk for air emboli during hemodialysis and the need to rapidly recognize symptoms and start treatment, including HBOT, to optimize recovery.
我们在此描述了首例因功能失调的长期血液透析中心静脉导管导致脑空气栓塞（CAE）的病例，患者为一名39岁有肺移植病史的女性。空气栓塞是血液透析中罕见但可能致命的并发症，尤其是当累及脑部时。早期采用高压氧治疗（HBOT）对防止患者病情恶化至关重要。在该病例中，我们的患者在血液透析过程中首次出现症状，可能是由于多发性脑空气栓塞引发了癫痫发作。随后她按照医学参考中心的建议（采用HBOT）在肾脏病重症监护病房接受监测。12小时后，她出现继发性病情恶化，表现为急性失语、左侧偏侧忽视综合征和偏瘫。她被迅速转至医学参考中心接受HBOT治疗。患者在接受三次HBOT治疗后完全康复。她在每次HBOT治疗期间也出现癫痫发作，归因于高氧。自CAE发作后，她再也没有经历过癫痫发作。该病例凸显了对于有肺移植病史的患者，在血液透析期间发生空气栓塞风险增加的认识的重要性，以及快速识别症状并开始包括HBOT在内的治疗以优化康复效果的必要性。
