CEREBRAL-ISCHEMIA AFTER VENOUS AIR-EMBOLISM IN THE ABSENCE OF INTRACARDIAC DEFECTS

Cerebral air embolism occurred in a patient undergoing posterior fossa surgery performed in the sitting position for acoustic neuroma remova l. The patient experienced two episodes of venous air embolism, as evi denced by precordial Doppler, end-tidal carbon dioxide reduction, and oxygen desaturation. In both cases, air was aspirated from the central venous catheter; during the second episode there was arterial hypoten sion and electrocardiogram changes, and air bubbles were visualized in the cerebellar arteries. The patient did not regain consciousness aft er surgery and developed early tonic-clonic convulsions and electroenc ephalogram status epilepticus, which was treated with barbiturate coma . Intracardiac septal defects were not detected by transesophageal ech ocardiography, and computerized tomography of the brain demonstrated m ultifocal discrete ischemic areas in the cerebral hemispheres. The pat ient died 6 days after surgery without having regained consciousness. This case appears to represent the occurrence of transpulmonary passag e of venous air embolism.