The viewer will be able to explore the pathophysiology, presentations, imaging findings, and rapid treatments seen in cases of cerebral air emboli.

Interventions performed in a hospital setting allow for communication of outside air with internal structures. Surgery, trauma, vascular interventions, and barotrauma from mechanical ventilation increase risk of possible venous or arterial air emboli. Additional concerns arise when indwelling lines are used in an outpatient setting. Arterial cerebral air embolism (CAE) and cerebral venous air embolism (CVAE) are uncommon, but potentially catastrophic events. Patients can present with a wide variety of focal neurologic deficits, seizures, or coma.

Three patients seen at a military treatment facility were found to have cerebral air emboli requiring rapid hyperbaric treatment. Patient 1 presented due to concern for stroke after receiving TPN at home. Patient 2 became obtunded after outpatient pulmonary washout procedure. Patient 3 had a venous catheter removed while admitted to the hospital followed by acute change in mental status.

 This case series reviews instances of CAE caused by 3 different procedures. Due to the severity of complications, a high index of clinical suspicion is needed to identify patients with cerebral air embolism. The low sensitivity of initial CT imaging and the non-specific clinical presentation can make this difficult. The rarity of such a case requires providers to quickly perform maneuvers and treatment to improve patient outcome. Cerebral air emboli, venous or arterial, require emergent treatment to limit endothelial damage. Changes in position, volume expansion, supplemental oxygen and other supportive measures can stabilize a patient while hyperbaric oxygen treatment is arranged. The gold standard of treatment involves the use of hyperbaric chamber, which may not be readily available, making the need for knowledge of other emergent interventions invaluable.