Convulsive syndrome as a manifestation of acute cerebral damage due to paradoxical air embolism in neurosurgical patients. Series of clinical cases and literature review

Abstract

Paradoxical air embolism (PAE) is a rare potentially fatal complication followed by entering of air emboli from the right cardiac chambers and pulmonary artery to large circulation circle. To analyze five patients who underwent neurosurgical intervention complicated by PAE and early postoperative convulsive syndrome. There were five patients who developed early postoperative convulsive syndrome after previous neurosurgery in sitting position complicated by PAE. Convulsive syndrome required intensive care at the ICU. MRI confirmed ischemic foci de novo outside the zone of surgical intervention in all cases. All patients underwent video-EEG monitoring in order to select anticonvulsant therapy and evaluate its effectiveness. The authors were able to match the epileptogenic focus in the cerebral cortex with MRI data. Available literature data devoted to the problem of convulsive syndrome after neurosurgery complicated by PAE were analyzed. The focus of epileptiform activity coincided with one of the foci of hyperintense MR signal in all cases. Video-EEG monitoring is advisable in patients with impaired consciousness who underwent neurosurgery complicated by PAE.