Symptomatic Cerebral Air Embolism after Central Venous Catheter Removal. (P1.034)

OBJECTIVE: To report an unusual cause of acute ischemic stroke that resulted from air embolism after central venous catheter removal. BACKGROUND: Air in the magnetic field has very low magnetic susceptibility and can cause signal loss on MRI, especially on GRE. The positive findings of cerebral air embolism on a T2-weight gradient-echo image were previously reported. To our knowledge, no serial DWI and GRE in patients with cerebral air embolism have been reported. DESIGN/METHODS: A 76-year-old female was admitted to the ICU for treatment of septic shock secondary to urinary tract infection complicated by gastrointestinal and genitourinary bleeding. She required central line placement for vascular access. The patient improved significantly after treatment with antibiotics and IV fluid replacement. Thereafter, central venous catheter was removed. Soon after removal of the catheter the patient developed acute onset of severe left sided weakness and global aphasia. Neurological examination showed complete left sided hemiplegia with complete sensory loss, right gaze preference, severe aphasia, left upper motor neuron facial weakness and left hemi-neglect. CT scan showed multiple small air bubbles at the right frontal sulcus. MRI revealed the acute ischemic changes corresponding to the prior CT scan with multiple low intensity lesions on gradient-echo imaging. The follow up GRE demonstrated near resolution of hypointense lesions. Given the relevant history and the radiographic results, cerebral air embolism was our impression. Transthoracic echocardiogram confirmed the presence of an intra-cardiac shunt (PFO). The patient had excellent recovery over the next few days with significant improvement of the neurological deficits. CONCLUSIONS: Central air embolism is a rare complication of central venous catheter removal or insertion. GRE or DWI is useful for diagnosis of cerebral air embolism. Clinician should be aware of this uncommon complication and take the necessary precaution to prevent it. Disclosure: Dr. Ferdous has nothing to disclose. Dr. Tantikittichaikul has nothing to disclose. Dr. Hasan has nothing to disclose. Dr. Eldokla has nothing to disclose. Dr. Kim has nothing to disclose.