Acute Ischaemic Stroke by a Different Mechanism

Abstract

Central venous lines are often inserted but their removal requires some precautions. We describe a 51-year-old female patient who was due for discharge but had an unfortunate event arising from removal of her central venous line even though the appropriate measures had been taken. She experienced an acute ischaemic stroke secondary to air embolism. The deficits persisted even though extensive efforts were made to reverse them. This case reminds clinicians that bedside procedures can result in devastating complications even if all precautions have been followed. We review the mechanisms of air embolism, provide suggestions to limit its incidence following central line removal, and recommend therapeutic measures.

Learning points: Precautions should be taken when removing a central venous line to reduce the risk of air embolism.Air embolism can manifest with acute stroke.Acute stroke in this setting requires hyperbaric oxygen therapy.

Keywords: Air embolism; central venous line; stroke.

Figure 1

Axial and coronal CT of the head showing air within the cerebral sulci (arrows)

Figure 2

CT of the neck showing a gas pocket in the distal right internal jugular vein (arrow)

Figure 3

MRI of the brain (fluid-attenuated inversion recovery image) showing hyperintensity of the right frontal and parietal lobes (arrow)