Cerebral gas embolism caused by pleural fibrinolytic treatment

BACKGROUND AND PURPOSE: Intrapleural fibrinolytic therapy is a technique used to treat empyemas and parapneumonic effusions. Cerebral air embolism is an unusual potentially severe complication of this technique.

SUMMARY OF CASE: A patient with parapneumonic pleural effusion underwent pleural lavage with streptokinase when he suddenly demonstrated focal neurological signs and seizures. The CT revealed multiple air-isodense spots in right hemisphere of the brain, suggesting cerebral air embolism. As a result of early diagnosis and emergency hyperbaric oxygenation, the patient recovered without delayed sequelae.

CONCLUSIONS: Air embolism is a potentially severe complication which can occur during fibrinolytic pleural lavage, and clinicians should be aware of this risk. In this context, the onset of acute focal neurological signs or seizures should suggest the possibility of air embolism and lead to the transfer of the patient close to a hyperbaric facility within a few hours.

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Menéndez-González M, Oliva-Nacarino P, Alvarez-Cofiño A. Cerebral gas embolism caused by pleural fibrinolytic treatment. Stroke. 2007 Sep;38(9):2602-4. Epub 2007 Aug 2.