Abstract
CaseA 44‐year‐old man intentionally stabbed himself in the anterior neck and left thorax with a fruit knife. Physical examination revealed two open wounds entering the thoracic cavity in the front chest, and a stab wound entering the trachea at the neck. Two chest tubes were initially inserted for the left lung injury with open hemopneumothorax. Nevertheless, the worsening oxygenation required positive pressure ventilation (PPV) with endotracheal intubation.OutcomeRight hemiparesis was found during weaning from PPV. Magnetic resonance imaging revealed multiple infarctions in the area of the bifrontal and right temporal lobes. Cerebral air embolism (CAE) was strongly suspected from the imaging findings and clinical course.ConclusionWe concluded that mechanical ventilation was strongly involved in the occurrence of CAE. If delayed abnormal neurological findings are observed in patients with penetrating lung injuries receiving PPV management, CAE should be considered.
Highlights
C EREBRAL AIR EMBOLISM (CAE) is caused by air bubbles in the vascular system
We report a rare case of delayed CAE caused by a chest stab wound, and review published works
Penetrating chest trauma could be a rare cause of late-onset CAE
Summary
C EREBRAL AIR EMBOLISM (CAE) is caused by air bubbles in the vascular system. These bubbles obstruct the intracranial blood vessels, and lead to symptoms of cerebral ischemia. Cerebral air embolism is commonly caused by arterial catheterization, barotrauma, decompression sickness, iatrogenic interventions, and trauma.[1] Little is known about CAE associated with severe penetrating chest trauma. Physical examination revealed three stab wounds: one was a neck wound (approximately 4 cm) that penetrated the trachea, and the others were chest wounds (approximately 1.5 cm and 4 cm) that entered the thoracic cavity from the left front chest. Contrast-enhanced computed tomography (CT) of the patient’s neck and chest showed s.c. emphysema, pneumomediastinum, tracheal injury, right pneumothorax, left hemopneumothorax, and intrapulmonary hemorrhage. Three hours later ICU admission, another chest tube was inserted in the left thoracic cavity due to progressive aggravation of s.c. emphysema and oxygenation. On the 18th day after admission, right hemiparesis improved after rehabilitation; the manual muscle test grade of the right upper extremity was 5/5 and that of the right lower extremity was 4/5. The patient was transferred to another hospital on the 56th day after admission
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