Cerebral Venous Air Embolism: A Rare Clinical Challenge and Management Insights

Abstract

Cerebral air embolism (CAE) is a rare but life-threatening condition often associated with trauma, such as chest and skull injuries, which allow air to enter the venous system, as well as medical procedures and surgical interventions. It can occur during the insertion of peripheral cannulas or central midline catheters, following lung biopsy procedures, or during vascular surgeries, particularly those involving the head and neck region. CAE can also develop during the removal of central venous cannulas, as air may enter the bloodstream in the process. When air enters the bloodstream, it can travel to the cerebral blood vessels, where it may be trapped, forming bubbles that obstruct the blood flow. This blockage reduces oxygen supply to brain tissue, which can quickly lead to cell damage or ischemia if not resolved. We present the case of a 62-year-old male with an infective exacerbation of chronic obstructive pulmonary disease who developed acute unilateral sensorimotor weakness several days following midline catheter insertion for a prolonged course of antibiotic administration. Prompt detection and intervention are essential in managing CAE to minimize risks and prevent permanent damage. The role of diagnostic radiology is essential in the rapid diagnosis and management of CAE. Imaging techniques such as computed tomography (CT) scans, carotid and cerebral angiograms, and magnetic resonance imaging (MRI) of the head are invaluable for assessing cerebral arteries and determining the extent of ischemic damage over time. They can also show signs of air trapped either in the venous or arterial system as the complexity of CAE is heightened by air emboli affecting various vascular regions, including the cerebral venous sinuses, requiring comprehensive imaging for accurate diagnosis and management. While CT of the brain is essential for immediate diagnosis, follow-up MRI scans provide detailed insights into the progression of ischemic changes that may result from CAE.

Keywords: carotid artery imaging; cerebral venous embolism; chronic obstructive pulmonary disease; imaging diagnostic radiology in cerebral air embolism; ischemic lesion; neurovascular radiology.

Figure 1. CT of the head axial non-contrast demonstrates a few small gas locules in the right centrum semi-ovale in keeping with air emboli.

CT: computed tomography

Figure 2. CT of the head axial non-contrast on lung windows allows for better visualization of the gas locules.

CT: computed tomography

Figure 3. CT of the head axial non-contrast demonstrates a few small gas locules in the right centrum and the left semi-ovale in keeping with air emboli.

CT: computed tomography

Figure 4. CT carotid angiogram sagittal section showing mild calcified atherosclerotic plaque just at the left carotid bifurcation. No significant intracranial stenosis or occlusion can be seen.

CT: computed tomography

Figure 5. SWI on MRI of the head axial view demonstrates multiple corresponding focal areas of signal drop without a blooming artifact. No ischemic changes can be seen on the MRI.

SWI: susceptibility-weighted imaging; MRI: magnetic resonance imaging

Figure 6. Complete resolution of the previously observed cerebral air emboli in Figure 1.