[Arterial gas embolism progressing to a massive stroke]. / Embolismo gaseoso arterial con evolución a accidente cerebrovascular masivo.

INTRODUCTION: Arterial gas embolism (AGE) is a main iatrogenic complication resulting from the use of invasive procedures. It is difficult to diagnose if it is not clinically suspected. CASE REPORT: A 67-year-old male patient, with a history of interventions involving a mitral prosthesis and a double aortocoronary bypass, who visited Emergency room with symptoms of a high temperature and general malaise. He was canalised peripherally and the electrocardiogram (ECG) showed an auricular fibrillation that had already been detected. While under observation he suffered a loss of consciousness, generalised hypotonia, conjugated gaze deviation towards the right, lower left facial paralysis and left Babinski positive. A new ECG showed ST segment elevation in V2-V5. A cranial computerised tomography (CAT) scan with no contrast revealed a number of serpiginous images caused by the presence of air in vascular structures. A second cranial CAT scan showed the disappearance of the visible air and signs of ischemic stroke in the territory of the right middle and posterior cerebral arteries and the left middle cerebral artery. Clinical-radiological findings suggested an AGE in the brain with massive stroke and acute myocardial infarct with similar causation. CONCLUSIONS: It is not clear what caused the air embolism in this patient but it can most probably be explained by air accidentally entering a peripheral vein. Carrying out an early cranial CAT scan can provide us with a diagnosis and a later CAT scan can evaluate the consequences of the embolism.

Embolismo gaseoso arterial con evolución a accidente cerebrovascular masivo / Arterial gas embolism progressing to a massive stroke

Introducción. El embolismo gaseoso arterial (EGA) es una complicación principalmente yatrogénica, causada por el uso de procedimientos invasivos. Su diagnóstico es difícil si no se sospecha clínicamente. Caso clínico. Varón de 67 años, con antecedente de intervención de prótesis mitral y doble derivación aortocoronaria, que acude a Urgencias con un síndrome febril y mal estado general. Se le canaliza una vía periférica, y en el electrocardiograma (ECG) muestra una fibrilación auricular ya conocida. Mientras estaba en observación, sufre pérdida de conciencia, hipotonía generalizada, desviación de la mirada conjugada a la derecha, parálisis facial inferior izquierda y Babinski izquierdo positivo. Un nuevo ECG muestra supradesnivel del segmento ST de V2 a V5. En la tomografía computarizada (TC) craneal sin contraste se observan múltiples imágenes serpiginosas por aire en estructuras vasculares. Una segunda TC craneal muestra la desaparición del aire visible y signos de accidente cerebrovascular isquémico en el territorio de las arterias cerebral media y posterior derechas y cerebral media izquierda. Los hallazgos clinicorradiológicos sugieren un EGA cerebral con infarto cerebral masivo, e infarto agudo de miocardio de origen similar. Conclusiones. La causa del embolismo aéreo en este paciente no está clara, y la más probable es la entrada accidental de aire en la vía venosa periférica. La realización de una TC craneal precoz puede dar el diagnóstico, y una TC tardía puede valorar las consecuencias del embolismo (AU)

Introduction. Arterial gas embolism (AGE) is a main iatrogenic complication resulting from the use of invasive procedures. It is difficult to diagnose if it is not clinically suspected. Case report. A 67-year-old male patient, with a history of interventions involving a mitral prosthesis and a double aortocoronary bypass, who visited Emergency room with symptoms of a high temperature and general malaise. He was canalised peripherally and the electrocardiogram (ECG) showed an auricular fibrillation that had already been detected. While under observation he suffered a loss of consciousness, generalised hypotonia, conjugated gaze deviation towards the right, lower left facial paralysis and left Babinski positive. A new ECG showed ST segment elevation in V2-V5. A cranial computerised tomography (CAT) scan with no contrast revealed a number of serpiginous images caused by the presence of air in vascular structures. A second cranial CAT scan showed the disappearance of the visible air and signs of ischemic stroke in the territory of the right middle and posterior cerebral arteries and the left middle cerebral artery. Clinical-radiological findings suggested an AGE in the brain with massive stroke and acute myocardial infarct with similar causation. Conclusions. It is not clear what caused the air embolism in this patient but it can most probably be explained by air accidentally entering a peripheral vein. Carrying out an early cranial CAT scan can provide us with a diagnosis and a later CAT scan can evaluate the consequences of the embolism (AU)