Skip to main content Accessibility help
×
Home
Hostname: page-component-568f69f84b-n9pbb Total loading time: 0.342 Render date: 2021-09-22T17:40:21.041Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Cerebral Air Embolism During Air Flight—Neuroimaging and Management

Published online by Cambridge University Press:  12 August 2016

David Brennan*
Affiliation:
Department of Neurology, Beaumont Hospital, Dublin, Ireland
Paul Brennan
Affiliation:
Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
James O’Rourke
Affiliation:
Department of Anaesthesia and Intensive Care Medicine, Beaumont Hospital, Dublin, Ireland.
Seamus Looby
Affiliation:
Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
*Corresponding
Correspondence to: David Brennan, 53 Sandymount Road, Sandymount, Dublin 4, Ireland. Email: davidbrennan@rcsi.ie.
Rights & Permissions[Opens in a new window]

Abstract

Type
Neuroimaging Highlights
Copyright
Copyright © The Canadian Journal of Neurological Sciences Inc. 2016 

This is the case of a 69-year-old woman with chronic obstructive pulmonary disease who rapidly lost consciousness during an air flight, necessitating emergency landing shortly after takeoff. Noncontrast computed tomography of the brain showed two locules of air (Figure 1A) in the right frontal and parietal lobes. Magnetic resonance imaging of the brain showed scattered foci of diffusion restriction (Figure 1B,C), ill-defined vasogenic edema (Figure 1D,E), and microhemorrhages (Figure 1F) in the right frontal and parietal lobes. The findings were consistent with cerebral air embolism and resultant right middle cerebral artery territory infarction. Computed tomography of the thorax (Figure 2) showed a large right apical bulla and extensive emphysematous changes. The patient was treated with full supportive measures in an intensive care setting. The patient eventually made a good clinical and neurological recovery.

Figure 1 Axial noncontrast computed topography (CT) of the brain (A) showed intraparenchymal air in the right frontal and parietal lobes (arrows). Axial magnetic resonance (MR) diffusion (B) and apparent diffusion coefficient (ADC) map (C) sequences showed foci of diffusion restriction in the right frontoparietal white matter. T2 (D) and fluid-attenuated inversion recovery (FLAIR) (E) sequences showed vasogenic edema. A susceptibility-weighted imaging (SWI) sequence (F) showed right parietal microhemorrhages (arrow).

Figure 2 Axial computed topography (CT) of the thorax lung windows (A, B) show diffuse emphysematous changes including a large right apical bulla (arrow).

Only a small number of similar cases have been reported in literature.Reference Gudmundsdottir, Geirsson, Hannesson and Gudbjartsson 1 Cerebral air emboli are very rare but can occur secondary to central venous catheter insertion, cardiothoracic surgery, chest trauma, deep sea diving, or rupture of a lung bulla or cyst.Reference Sviri, Woods and van Heerden 2 In this case, the mechanism was likely related to external decompression during air flight ascent. Boyle’s law states that gas volume is inversely proportional to the pressure exerted upon it.Reference Yeung, Ma, Mak and Lam 3 Cabin pressure dropping by up to 200 mmHg routinely between ground level and cruising altitude can lead to a 33% expansion in the volume of pulmonary bullae or cysts.Reference Zaugg, Kaplan, Widmer, Baumann and Russi 4 This can result in microscopic tears or rupture of the lining of the bullae. Air locules or bubbles can then track into the adjacent small blood vessels and into the systemic circulation. The brachiocephalic trunk is the most proximal of the great vessels of the aorta and is preferentially affected. Air bubbles can then flow through to the right middle cerebral artery, leading to occlusion of smaller vessels and resultant infarction. However, neurological deficits with cerebral air emboli may be reversible. Providing 100% oxygen may reduce the size of the air locules by depleting nitrogen and restore blood flow to an occluded artery. Hyperbaric therapy compresses the bubbles and steroids reduce cerebral edema. However, in patients with chronic obstructive pulmonary disease and large bullae, such treatments carry the risk of further bulla rupture.Reference Yeung, Ma, Mak and Lam 3 , Reference Edwardson, Wurth, Lacy, Fink and Becker 5

The vast majority of cases of cerebral air embolism in the medical literature prove fatal; thus, early recognition and diagnosis with the radiographic techniques described here is essential.

Disclosures

None of the authors has anything to disclose.

Statement of Authorship

DB researched, drafted, and developed the manuscript. PB helped evaluate and edit the manuscript. JO’R acquired manuscript data. SL supervised and helped in manuscript development, editing, and evaluation.

References

1. Gudmundsdottir, JF, Geirsson, A, Hannesson, P, Gudbjartsson, T. Major ischaemic stroke caused by an air embolism from a ruptured giant pulmonary bulla. BMJ Case Rep. 2015;March 5;2015. Epub.Google Scholar
2. Sviri, S, Woods, WP, van Heerden, PV. Air embolism-a case series and review. Crit Care Resusc. 2006;6:271-276.Google Scholar
3. Yeung, J, Ma, J, Mak, YF, Lam, V. Fatal cerebral air embolism related to an air flight. Hong Kong Med J. 2013;19:352-353.CrossRefGoogle Scholar
4. Zaugg, M, Kaplan, V, Widmer, U, Baumann, PC, Russi, EW. Fatal air embolism in an airplane passenger with a giant intrapulmonary bronchogenic cyst. Am J Respir Crit Care Med. 1998;157:1686-1689.CrossRefGoogle Scholar
5. Edwardson, M, Wurth, D, Lacy, JM, Fink, J, Becker, K. Cerebral air embolism resulting in fatal stroke in an airplane passenger with a pulmonary bronchogenic cyst. Neurocrit Care. 2009;10:218-221.CrossRefGoogle Scholar
Figure 0

Figure 1 Axial noncontrast computed topography (CT) of the brain (A) showed intraparenchymal air in the right frontal and parietal lobes (arrows). Axial magnetic resonance (MR) diffusion (B) and apparent diffusion coefficient (ADC) map (C) sequences showed foci of diffusion restriction in the right frontoparietal white matter. T2 (D) and fluid-attenuated inversion recovery (FLAIR) (E) sequences showed vasogenic edema. A susceptibility-weighted imaging (SWI) sequence (F) showed right parietal microhemorrhages (arrow).

Figure 1

Figure 2 Axial computed topography (CT) of the thorax lung windows (A, B) show diffuse emphysematous changes including a large right apical bulla (arrow).

You have Access
1
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Cerebral Air Embolism During Air Flight—Neuroimaging and Management
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Cerebral Air Embolism During Air Flight—Neuroimaging and Management
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Cerebral Air Embolism During Air Flight—Neuroimaging and Management
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *