Abstract
BackgroundCerebral air embolism is a rare cause of cerebral infarction. In cerebral air embolism, T2 star-weighted imaging shows numerous spotty hypointense signals. Previous reports have suggested that these signals represent air in the brain and are gradually diminished and absorbed. We experienced two cases of cerebral air embolism, and in one of them, we conducted an autopsy.Case presentationCase 1 was a 76-year-old Japanese man with lung cancer and emphysema. A spasmodic cough induced massive cerebral and cardiac air embolisms and the patient died because of cerebral herniation. T2 star-weighted imaging of brain magnetic resonance imaging showed multiple spotty low signals. Brain autopsy showed numerous spotty hemorrhagic infarcts in the area of T2 star-weighted imaging signals. Case 2 was an 85-year-old Japanese man with emphysema who suffered from acute stroke. Similar spotty T2 star-weighted imaging signals were observed and remained unchanged 2 months after the onset.ConclusionsThese findings indicate that T2 star-weighted imaging in cerebral air embolism partially represents micro-hemorrhagic infarction caused by air bubbles that have migrated into the brain.
Highlights
These findings indicate that T2 star-weighted imaging in cerebral air embolism partially represents micro-hemorrhagic infarction caused by air bubbles that have migrated into the brain
Cerebral air embolism is a rare cause of cerebral infarction
The findings suggest that the hypointense signals on T2 starweighted imaging (T2*WI)
Summary
Our cases of cerebral embolism are important in two aspects. Cerebral air embolism could have been caused without traumatic or iatrogenic causes. To the best of our knowledge, this is the first report showing that cerebral air embolism can cause multiple small hemorrhagic infarcts. Hypointense signals on T2*WI represent such small hemorrhagic infarcts. MT, TH, RM, YI: acquisition of data. MT, TH, RM, YI, NK: analysis and interpretation of data and critical revision of the manuscript for important intellectual content. MT, YI, NK: drafting of the manuscript. All authors read and approved the final manuscript. Author details 1 Department of Neurology, Kobe City Medical Center General Hospital, Hyogo, Japan. Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan. Department of Pathology, Kobe City Medical Center General Hospital, Hyogo, Japan
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