Abstract Details Title Unusual Cause of Acute Ischemic Stroke: A Case of Cerebral Air Embolism Post Transthoracic Lung Biopsy Topic Cerebrovascular Disease and Interventional Neurology Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM) Poster/Presentation Number 3-002 Objective Cerebral air embolism is an uncommon cause of acute ischemic stroke. Clinical features and imaging findings of a patient who underwent Trans-thoracic Lung Biopsy (TLB) and developed stroke are discussed here. Background Cerebral air embolism is a rare complication of TLB, with a prevalence of 0.02-0.4%. Although asymptomatic scenarios have been occasionally reported in this setting, acute ischemic stroke due to occlusion of cerebral circulation is a major concern. Altered mental status or new neurologic deficit necessitates further evaluation with CT head and subsequent MRI brain. Design/Methods A 59-year-old male with past medical history of renal cell carcinoma presented for TLB of his growing pulmonary nodules. At IR suit, immediately after first needle pass, the patient got unresponsive with a drop in O2 saturations which required intubation. Given the acuity of symptoms, CT head was ordered immediately which demonstrated multiple foci of air in bilateral parietal and left occipital cortical sulci, likely due to cerebral air embolism. With no improvement in patient’s clinical condition, MRI brain was performed a few hours later which demonstrated scattered areas of restricted diffusion in the bilateral cerebral hemispheres, the corpus callosum and bilateral cerebellar hemispheres, compatible with recent embolic ischemic infarcts. Patient went under hyperbaric oxygen therapy. Few days later, he could respond to stimuli and 10 days later he was able to talk and was discharged to a rehabilitation facility with residual left-sided weakness. Results NA Conclusions Acute ischemic stroke due to cerebral air embolism is a rare complication of TLB which can be associated with significant disability. CT and MRI play a seminal role in the immediate diagnosis of this entity, as air absorbs rapidly in most cases. Neurologists should be aware of this uncommon form of stroke, its follow up and treatment options. Authors/Disclosures Golshan Fahimi, MD PRESENTER Dr. Fahimi has nothing to disclose. No disclosure on file