Neurological complications and pleural lavage with a fibrinolytic agent. Atwo-case report.

We report on an unusual, albeit potentially severe, complication of the per formance of a pleural lavage with streptokinase in two patients demonstrati ng parapneumonic pleural effusion. During the time they underwent repeated pleural lavages with saline and streptokinase, they suddenly demonstrated f ocal neurological signs. As a result of early diagnosis and emergency hyper baric oxygenation, both patients recovered without delayed sequelae. Air em bolism is a potentially severe complication which can occur during pleural lavage. Whether streptokinase increases the risk of opening a latent vascul ar breach cannot be definitely established, but clinicians should be aware of this risk. In this context, the onset of acute focal neurological signs should suggest the possibility of air embolism and lead to the transfer of the patient close to a hyperbaric facility within a few hours.