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Cerebral air embolism from angioinvasive cavitary aspergillosis.

Lin C, Barrio GA, Hurwitz LM, Kranz PG - Case Rep Neurol Med (2014)

Bottom Line: Over the course of 48 hours, her symptoms significantly improved.Conclusion.This case highlights the importance of considering atypical causes of acute ischemic stroke.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Duke University, Durham, NC 27710, USA.

ABSTRACT
Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL). Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA) branches. She was emergently taken for hyperbaric oxygen therapy (HBOT). Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke.

No MeSH data available.


Related in: MedlinePlus

Air emboli on CT (a), CTA (b), and infarction on DWI sequence of MRI (c).
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fig1: Air emboli on CT (a), CTA (b), and infarction on DWI sequence of MRI (c).

Mentions: On the morning of hospital day 55, a normal neurologic exam was noted at 9 am. At 9:40 am, the patient rose from bed, felt dizzy, and slid to the floor. She was initially able to explain that she felt weak. Nursing noted no jerking movements of her extremities or bowel or urinary incontinence. Capillary blood glucose and vitals were unremarkable with glucose of 160, pulse 90 s, BP 120 s/60 s, and O2 96% on room air. When primary team arrived, they noted a right facial droop, severe aphasia, with right upper and right lower extremity paresis. They called a stroke code at 9:53 am with neurology evaluation starting at 9:58 am. Her initial exam confirmed a global aphasia and right-sided hemiplegia. Her initial NIH stroke scale was 18. She was taken for emergent CT and CT-Angiography of the head and neck. She was found to have foci of intravascular air within the distal portion of the M1 segment of the left MCA, as well as additional foci of intravascular air in the branches of the inferior division of the left MCA (Figure 1). Hyperbaric service was emergently contacted to get her treatment with eventual transport to chamber by 6 pm. She completed a US Navy Treatment Table 6 protocol with no significant difficulties. After the HBOT, she had improvement of motor strength in her right arm. Her speech was spontaneous but she provided inappropriate words for the questions asked.


Cerebral air embolism from angioinvasive cavitary aspergillosis.

Lin C, Barrio GA, Hurwitz LM, Kranz PG - Case Rep Neurol Med (2014)

Air emboli on CT (a), CTA (b), and infarction on DWI sequence of MRI (c).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150411&req=5

fig1: Air emboli on CT (a), CTA (b), and infarction on DWI sequence of MRI (c).
Mentions: On the morning of hospital day 55, a normal neurologic exam was noted at 9 am. At 9:40 am, the patient rose from bed, felt dizzy, and slid to the floor. She was initially able to explain that she felt weak. Nursing noted no jerking movements of her extremities or bowel or urinary incontinence. Capillary blood glucose and vitals were unremarkable with glucose of 160, pulse 90 s, BP 120 s/60 s, and O2 96% on room air. When primary team arrived, they noted a right facial droop, severe aphasia, with right upper and right lower extremity paresis. They called a stroke code at 9:53 am with neurology evaluation starting at 9:58 am. Her initial exam confirmed a global aphasia and right-sided hemiplegia. Her initial NIH stroke scale was 18. She was taken for emergent CT and CT-Angiography of the head and neck. She was found to have foci of intravascular air within the distal portion of the M1 segment of the left MCA, as well as additional foci of intravascular air in the branches of the inferior division of the left MCA (Figure 1). Hyperbaric service was emergently contacted to get her treatment with eventual transport to chamber by 6 pm. She completed a US Navy Treatment Table 6 protocol with no significant difficulties. After the HBOT, she had improvement of motor strength in her right arm. Her speech was spontaneous but she provided inappropriate words for the questions asked.

Bottom Line: Over the course of 48 hours, her symptoms significantly improved.Conclusion.This case highlights the importance of considering atypical causes of acute ischemic stroke.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Duke University, Durham, NC 27710, USA.

ABSTRACT
Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL). Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA) branches. She was emergently taken for hyperbaric oxygen therapy (HBOT). Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke.

No MeSH data available.


Related in: MedlinePlus