Objective:

Cerebral venous air embolism (CVAE) is a rare, but dangerous phenomenon that is generally iatrogenic via the placement of central venous catheters or intravenous medications. However, this case highlights a unique etiology of CVAE resulting from chemical ingestion.

Background:

A 72-year-old female presented with right-sided weakness following the accidental ingestion of a household cleaner. Right pronator drift and sensory deficits were seen on exam. Approximately 15 minutes after arrival her symptoms resolved spontaneously in the emergency room and, CT/CT angiography were unrevealing. MRI Brain demonstrated multifocal bi-hemispheric areas of acute ischemia. On endoscopy, multiple gastric erosions were appreciated consistent with a Grade 2A caustic injury, and a collection of portal venous gas was seen on CT. Given the collection of portal venous gas, CVAE was the leading differential diagnosis. Sodium percarbonate, a powerful oxidizer and the active ingredient in many cleaning agents, reacts with water to form hydrogen peroxide, which further breaks down into oxygen gas. This formation of gas in proximity to the eroded gastrointestinal mucosa resulted in the formation of gas emboli in the venous system. While it is possible that the air emboli have the possibility to travel through any undiscovered pulmonary AV fistula or through incomplete filtration across the pulmonary capillary beds, based on the likelihood of retrograde flow into the cranial venous system and the gyriform appearance of the ischemic changes seen on DWI, the leading diagnosis remained CVAE.

Design/Methods:

NA

Results:

NA

Conclusions:

CVAE is an uncommon but dangerous cause of ischemic stroke that should be considered, especially in the critical care setting. Recognition of this phenomenon and early intervention with Durant’s maneuver (Trendelenburg, left lateral decubitus) and high flow oxygen therapy can be crucial in reducing morbidity. Hyperbaric oxygenation can be utilized when available.