Retrograde Cerebral Venous Gas Embolism: Could it be Possible?

Authors

  •   Sushil Chouhan Departments of Anaesthesiology, Saifee Hospital, Mumbai, Maharashtra
  •   Nabila Shaikh Departments of Anaesthesiology, Saifee Hospital, Mumbai, Maharashtra
  •   Tasneem Dhansura Departments of Anaesthesiology, Saifee Hospital, Mumbai, Maharashtra
  •   Amit Sharma Orthopaedics, Saifee Hospital, Mumbai, Maharashtra

Keywords:

Cerebral venous gas embolism, hyperbaric oxygen therapy, postoperative seizures, retrograde

Abstract

Air embolism is well-known but uncommon and cerebral venous gas embolism (CVGE) is even more so because it goes unnoticed in an anaesthetized patient, especially where slow entrainment of small amounts of air takes place over a period of time. A young American Society of Anesthesiologists (ASA) status I patient underwent a lumbar spine surgery and presented in the post anaesthesia care unit (PACU) with seizures. Common causes of generalised tonic clonic seizures were ruled out and cerebral hypoperfusion as a result of retrograde CVGE was the retrospective diagnosis of exclusion. The patient developed retrograde CVGE in the absence of any intracardiac septal defect or patent foramen ovale. The prone positioning along with the anatomy of the valveless vertebral plexus of veins plays an important role in the development of retrograde CVGE. A high index of suspicion and awareness is warranted from anaesthesiologists so as not to delay diagnosis and treatment of this rare entity.

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Published

2017-01-01

How to Cite

Chouhan, S., Shaikh, N., Dhansura, T., & Sharma, A. (2017). Retrograde Cerebral Venous Gas Embolism: Could it be Possible?. Karnataka Anaesthesia Journal, 3(1), 10–12. Retrieved from https://karnatakaanesthesiajournal.in/index.php/kaj/article/view/138919

Issue

Section

Case Reports

References

Bothma PA, Schlimp CJ. Retrograde cerebral venous gas embolism: Are we missing too many cases? Br J Anaesth 2014;112:401-4.

Ploner F, Saltuari L, Marosi MJ, Dolif R, Salsa A. Cerebral air emboli with use of central venous catheter in mobile patient. Lancet 1991;338:1331.

Schlimp CJ, Loimer T, Rieger M, Lederer W, Schmidts MB. The potential of venous air embolism ascending retrograde to the brain.J Forensic Sci 2005;50:906-9.

Butler BD, Hills BA. The lung as a filter for microbubbles. J Appl Physiol 1979;47:537-43.

Chorost MI, Wu JT, Webb H, Ghosh BC. Vertebral venous air embolism: An unusual complication following colonoscopy: Report of a case. Dis Colon Rectum 2003;46:1138-40.

Albin MS, Ritter RR, Pruett CE, Kalff K. Venous air embolism during lumbar laminectomy in the prone position: Report of three cases. Anesth Analg 1991;73:346-9.

Despond O, Fiset P. Oxygen venous embolism after the use of hydrogen peroxide during lumbar discectomy. Can J Anaesth 1997;44:410-3.

Harrington KD. Major neurological complications following percutaenous vertebroplasty with polymethylmethacrylate: A case report. J Bone Joint Surg Am 2001;83-A:1070-3.

Narimatsu E, Kawamata M, Hase M, Kurimoto Y, Asai Y, Namiki A.Severe paradoxical intracranial embolism and pulmonary emboli during hip hemiarthroplasty. Br J Anaesth 2003;91:911-3.

Bothma PA, Brodbeck AE, Smith BA. Cerebral venous air embolism treated with hyperbaric oxygen: A case report. Diving Hyperb Med 2012;101-3.