Cerebral air embolism without invasive medical procedures diagnosed by characteristic hypointense signal on T2*-weighted imaging

DOI Web Site 10 References
  • Iwamoto Munenori
    Division of Internal Medicine, Hyogo Prefectural Tamba Medical Center
  • Otsuka Yoshihisa
    Division of Internal Medicine, Hyogo Prefectural Tamba Medical Center
  • Kato Ayumi
    Division of Internal Medicine, Hyogo Prefectural Tamba Medical Center
  • Yawata Godai
    Division of Internal Medicine, Hyogo Prefectural Tamba Medical Center
  • Imura Jun
    Division of Neurosurgery, Hyogo Prefectural Tamba Medical Center
  • Okamura Yusuke
    Division of Neurosurgery, Hyogo Prefectural Tamba Medical Center
  • Matsumoto Kensuke
    Division of Internal Medicine, Hyogo Prefectural Tamba Medical Center

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Other Title
  • 侵襲的処置を伴わずに発症しT2*強調画像での特徴的な低信号が診断につながった脳空気塞栓症の1例

Abstract

<p>A 88-year-old woman was admitted to our hospital with exacerbation of chronic heart failure and urinary tract infection. She received antimicrobial agents through a peripheral venous catheter. On 12th day of hospitalization, she presented with sudden loss of consciousness and right hemiplegia. MRI revealed restricted diffusion in the border-zone territories between the left anterior cerebral artery (ACA) and middle cerebral artery (MCA). Furthermore, multiple hypointense signals were found in the cortices and the sulci of the border-zone territories on T2*-weighted imaging (T2*WI). CT showed air shadows almost matched on the hypointense signals on T2*WI, leading to the diagnosis of cerebral air embolism. On the following day, she showed the improvement of consciousness and hemiplegia. Air shadows on CT disappeared, simultaneously with vanishing of multiple hypointense signals on T2*WI. Some cases of cerebral air embolism in patients with peripheral venous catheter have been reported. Only few reports indicate the presence of multiple hypointense signals on T2*WI, as observed in the present case. Cerebral air embolism should be considered when hypointense signals in the cortices and the sulci are present on T2*WI, even if only a peripheral venous catheter is placed and invasive procedures have not been performed.</p>

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