Spontaneous massive retrograde venous cerebral air embolism: a case caused by pneumomediastinum diagnosed pathologically

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  • Mizutani Atsushi
    Emergency Medical Care Center, Hamamatsu Medical Center Department of Neurosurgery, Hamamatsu Medical Center
  • Nakayama Teiji
    Emergency Medical Care Center, Hamamatsu Medical Center Department of Neurosurgery, Hamamatsu Medical Center
  • Mori Hiroki
    Department of Pathology, Hamamatsu Medical Center
  • Sawashita Koji
    Department of Neurosurgery, Hamamatsu Medical Center
  • Kato Toshiya
    Emergency Medical Care Center, Hamamatsu Medical Center
  • Ozawa Takachika
    Department of Pathology, Hamamatsu Medical Center

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Other Title
  • 多量の静脈逆行性空気が原因であると病理学的に診断しえた脳空気塞栓症の1 例

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Abstract

Cerebral air embolism is uncommon but usually causes lethal condition. We report an extremely rare case of a massive cerebral air embolism with retrograde venous air embolism from pneumomediastinum. An 80-year-old male was found in comatose state with right dilated pupil, and admitted to our hospital. The CT scan revealed massive intracranial air. The air mostly existed in the right transverse sinus, sagittal sinus, temporal and bilateral front-parietal lobes. Because of severe brain swelling, he suffered from brain herniation. His condition was very hard to save, so we treated him conservatively. He died in a short time, and an autopsy was performed. The brain specimen revealed that the endovascular space of cerebral veins were filled with air, but the lumen of cerebral arteries were filled with red blood cells. Therefore, it was confirmed that the air was retrograded to cerebral veins. And pneumomediastinum was also confirmed by the autopsy. So we thought this massive air embolism was caused by pneumomediastinum. We should share the information of spontaneous air embolism by such mechanism in this rare case.

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