Elsevier

Journal of Neuroradiology

Volume 39, Issue 5, December 2012, Pages 364-367
Journal of Neuroradiology

Case report
Multimodal imaging approach to cerebral gas embolism lesions

https://doi.org/10.1016/j.neurad.2012.03.008Get rights and content

Summary

Cerebral gas embolism may be revealed by the sudden onset of unconsciousness sometimes after surgery or after diagnostic and therapeutic procedures. The clinical diagnosis may be difficult if the context is not relevant. Imaging can therefore play a crucial role in revealing the presence of intracranial gas bubbles on CT or MRI scans. This report is of a case of fatal cerebral gas embolism revealed by CT and MRI performed for deep and unexplained coma. Etiological diagnosis revealed the presence of a lung tumor invading the mediastinum, thus possibly allowing the migration of gas from the lung to the arterial cerebral circulation. A second MRI performed 8 days after the initial event with diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopic imaging (1H-MRSI) allowed better comprehension of the pathophysiological mechanisms of cerebral injury secondary to gas embolism by showing two kinds of cerebral lesions: white-matter vasogenic edema and cytotoxic gray-matter edema.

Section snippets

Case report

An adult male with a history of left pulmonary squamous cell carcinoma began to show respiratory failure in relation to pleural effusion, which was subsequently treated by pleural puncture. However, 2 h after the procedure, the patient fell into a coma [Glasgow Coma Scale (GCS) score = 3] and was referred to the intensive care unit.

A cerebral computed tomography (CT) scan (Fig. 1) was immediately performed, and revealed disseminated supratentorial cerebral gas bubbles (air-equivalent attenuation

Discussion

The present case report illustrates the importance of multimodal cerebral imaging for the diagnosis of cerebral gas embolism and for greater comprehension of the pathophysiological mechanisms underlying cerebral injuries. CT and MRI may also be helpful for demonstrating the presence of gas bubbles in the cerebral parenchyma during the early phase of cerebral gas embolism.

The initial MRI session performed with the first few hours after the onset of symptoms revealed no parenchymal signal

Conclusion

Cerebral CT and MRI scans can help in the diagnosis of air embolism in the acute phase by demonstrating the presence of cerebral air bubbles. However, multimodal imaging analysis (conventional MRI, DTI, 1H-MRSI and FDG–PET) of secondary cerebral injury would help to achieve a greater understanding of the underlying mechanisms of lesions. Indeed, such imaging would be able to distinguish two types of lesions: toxic white-matter injury with myelin and neuronal abnormalities, and vasogenic edema;

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

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