"Delayed Hyperbaric Oxygen Treatment For Cerebral Gas Embolism Can Still Be Life-Saving"- A Case Report

Abstract

BACKGROUND Cerebral Gas embolism (CGE) is an uncommon and often preventable iatrogenic complication. Any peri-procedural neurological event should raise suspicion of CGE and treatment started immediately. Hyperbaric Oxygen Therapy (HBOT) is the treatment of choice and early referral is essential. However, HBOT has been shown to be beneficial with full recovery even after delays as long as 60 hours. This report is written to increase awareness about recognition and management of this dreaded complication. CASE PRESENTATION We report a case of a patient who suffered a cardiac arrest secondary to CGE during routine coronary angiography followed by ventriculogram. After successful resuscitation, review of imaging revealed air in the left ventricle and CT brain showed parenchymal air locules with surrounding ischemic changes. Neurological examination showed hypertonic reflexes with extensor plantar response and intermittent seizures. HBOT was arranged but there was a delay of about 14 hours between diagnosis and arrival due to logistical reasons. On arrival, the patient was still having seizures intermittently despite the anti-epileptics and sedative infusions. Seizures stopped within 20 minutes of HBOT initiation and 4 more sessions were provided in the following 72 hours. CT brain done 48 hours later demonstrated mild edema but no residual air. Upon eventual discharge, the patient had a near full neurological recovery, except for a mild left hemiparesis. CONCLUSION Acute neurological symptoms after an invasive procedure, should raise the suspicion of CGE. Early HBOT is the treatment of choice as minutes are equal to saved brain cells. However delayed treatment can still be lifesaving and should be considered.