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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

The lungs showing a focus of air in the pulmonary vein (arrow in (a)) and cavitary lesion (arrowhead). (b) is a CT with contrast performed earlier to show that the air is located in a pulmonary vein (dashed circle).
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fig2: The lungs showing a focus of air in the pulmonary vein (arrow in (a)) and cavitary lesion (arrowhead). (b) is a CT with contrast performed earlier to show that the air is located in a pulmonary vein (dashed circle).

Mentions: To workup her air embolism, a chest CT confirmed the small left pneumothorax, along with a 2.8 × 2.4 cm consolidative focus in the right upper lobe with an air crescent sign, favored as developing necrosis. This was thought secondary from an angioinvasive aspergillosis infection into her left pulmonary vein with demonstration of intravascular air (Figure 2). Repeated transthoracic echocardiogram revealed negative saline microcavitation study immediately and after Valsalva which was unrevealing for a cardiac shunt. An MRI brain on hospital day 57 confirmed multiple areas of restricted diffusion within the left MCA territory (Figure 1).


Cerebral air embolism from angioinvasive cavitary aspergillosis.

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

The lungs showing a focus of air in the pulmonary vein (arrow in (a)) and cavitary lesion (arrowhead). (b) is a CT with contrast performed earlier to show that the air is located in a pulmonary vein (dashed circle).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: The lungs showing a focus of air in the pulmonary vein (arrow in (a)) and cavitary lesion (arrowhead). (b) is a CT with contrast performed earlier to show that the air is located in a pulmonary vein (dashed circle).
Mentions: To workup her air embolism, a chest CT confirmed the small left pneumothorax, along with a 2.8 × 2.4 cm consolidative focus in the right upper lobe with an air crescent sign, favored as developing necrosis. This was thought secondary from an angioinvasive aspergillosis infection into her left pulmonary vein with demonstration of intravascular air (Figure 2). Repeated transthoracic echocardiogram revealed negative saline microcavitation study immediately and after Valsalva which was unrevealing for a cardiac shunt. An MRI brain on hospital day 57 confirmed multiple areas of restricted diffusion within the left MCA territory (Figure 1).

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