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Abstract Details

Bronchoscopy-Associated Cerebral Arterial Air Embolism Presenting with Acute Ischemic Stroke and Status Epilepticus
Cerebrovascular Disease and Interventional Neurology
P12 - Poster Session 12 (5:30 PM-6:30 PM)
6-013
To describe a rare cause of iatrogenic air embolism, causing acute ischemic stroke complicated by status epilepticus.
The incidence of vascular air embolism during bronchoscopy is estimated to be 2.65 per 100,000 hospitalizations, with 30% of these involving endovascular procedures. A recent case report and literature review identified only 5 cases of cerebral arterial air embolism following bronchoscopy. A small minority of acute ischemic strokes present with seizures, even fewer with status epilepticus.
NA
An 81-year-old woman with past medical history significant for hypertension and CREST syndrome presented to an outside hospital for elective bronchoscopy with biopsy of pulmonary nodules. Post-procedurally, she was noted to have new left-sided hemiparesis. Non-contrast CT head demonstrated a small arterial air embolism in the right frontal lobe. She was brought to the Emergency Department and sustained a bilateral tonic-clonic seizure lasting 30 seconds, resolving with intravenous lorazepam. Prior to returning to her mental status baseline, she had recurrent seizure activity, refractory to benzodiazepines, requiring an intravenous phenytoin load, intubation for airway protection, and sedation with propofol. She was transferred to our institution’s neurocritical care unit where repeat CT head exhibited sulcal effacement and she was treated with hypertonic saline for cerebral edema. Continuous EEG did not reveal any epileptiform patterns but the patient was started on levetiracetam for her acute symptomatic seizures. MRI later revealed small infarcts in multiple vascular territories. She was ultimately extubated and at the time of discharge to short-term rehabilitation, her only deficit was 4+/5 strength throughout the left arm, which normalized by 1-month follow-up. She was eventually weaned off of levetiracetam in the outpatient setting.
This case adds to our understanding of this rare procedural complication and, given the complications of her stroke by status epilepticus and cerebral edema, highlights the potential severity of these injuries.
Authors/Disclosures
Harry Sutherland, MD
PRESENTER 		Dr. Sutherland has received publishing royalties from a publication relating to health care.
Christine Gummerson, MD (Yale University School of Medicine, Department of Neurology) Dr. Gummerson has received personal compensation in the range of $0-$499 for serving as a NeuroBytes faculty contributor with 好色先生.
Richa Sharma, MD (Massachusetts General Hospital, Brigham, Harvard) Dr. Sharma has received research support from NIH. Dr. Sharma has received intellectual property interests from a discovery or technology relating to health care.