SHM Converge Scientific Abstract ePoster Gallery-Not All Ischemic Strokes Are the Same

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This case report describes a rare cerebral air embolism (CAE) causing acute ischemic stroke after bedside pleural tPA administration through a PleurX catheter. CAE is an uncommon but serious iatrogenic complication in which air enters the arterial system and can cause neurologic and cardiac injury, sometimes fatal.<br /><br />The patient was a 79-year-old man with squamous cell carcinoma of the left lung, recurrent pleural effusion, prior VATS with talc pleurodesis, and a PleurX catheter. He arrived with worsening weakness, confusion, fever, hypoxia, and imaging concerning for empyema. Cardiothoracic surgery administered pleural tPA to improve drainage. Immediately afterward, he became unresponsive. Initial CT head and EEG were unrevealing, so he was intubated and placed on 100% oxygen to aid air bubble dissolution.<br /><br />Subsequent brain MRI showed multiple areas of diffusion restriction and enhancement consistent with embolic infarcts. Transthoracic echocardiography revealed a patent foramen ovale (PFO) with a strongly positive bubble study, which likely increased the risk that air could pass into the arterial circulation and reach the brain. The patient had poor neurologic recovery and was transitioned to comfort care.<br /><br />The authors note that iatrogenic cerebral air embolism has been reported after procedures such as surgery and catheterization, but only rarely after tPA administration. Hyperbaric oxygen therapy is considered the best treatment when available and initiated early, though 100% FiO2 is an acceptable alternative if hyperbaric therapy cannot be provided.<br /><br />The key takeaway is that sudden neurologic decline after a procedure should prompt immediate consideration of air embolism, as rapid recognition and treatment may improve neurologic outcomes.

Asset Subtitle

Monika Olejnik-Wilczynska

Meta Tag

Author List Bing Xue, Monika Olejnik-Wilczynska, Paul Zamarripa, Stephanie Mackenzie

Category Clinical Vignettes

Concept Arterial Air Embolism

Concept Acute Ischemic Stroke

Concept Hyperbaric Oxygen Therapy

Concept Iatrogenic Procedure

Concept Patent Foramen Ovale

Distinguished Non-Finalist

Presenter Organization Trinity Health Ann Arbor Hospital

Presenting Author Monika Olejnik-Wilczynska

Track Adult

Keywords

cerebral air embolism

acute ischemic stroke

pleural tPA

PleurX catheter

patent foramen ovale

empyema

hyperbaric oxygen therapy

iatrogenic complication

embolic infarcts

lung cancer

Arterial Air Embolism

Acute Ischemic Stroke

Hyperbaric Oxygen Therapy

Iatrogenic Procedure

Patent Foramen Ovale