To report a rare case of cerebral air embolism (CAE) following a routine pulmonary washout for an empyema, and to illustrate lessons from a literature search in hyperbaric medicine capabilities.

Pulmonary wash-out is a routine procedure in clinical practice in the treatment of pulmonary disease. While complications can occur, CAE is a rare occurrence reported in the literature. The optimal treatment for this rare complication is undefined, although hyperbaric therapy has been suggested as an intervention. We report a case of CAE secondary to pulmonary wash-out and a literature review of hyperbaric therapy focused for the neurology resident.

We present a case of a 50 year-old female with history of intellectual disability and epilepsy, admitted to the MICU from the pulmonology clinic for chest tube placement for persistent empyema. The patient developed acute onset obtundation with a left gaze deviation. While the initial CT head was unremarkable, follow-up MRI showed CAE with multifocal cortically based acute diffusion restriction in multiple vascular territories. The patient was treated with hyperbaric medicine therapy, but the patient subsequently expired. After case presentation, we will provide a literature review of hyperbaric therapy in CAE focused for the neurology resident. The objective of hyperbaric therapy in CAE is to dissolve air in the vasculature to prevent secondary injury. Early recognition and emergent therapy are critical to limit secondary injury. Many open clinical questions remain, including the optimal depth and duration of dives and how long after injury that intervention is helpful. Neurology residents should be aware of the treatment medium for patients with this rare complication.

Neurologists should consider CAE on their differential in setting of acute change in neurologic presentation in setting of recent pulmonary washout. Additionally, if concern for CAE exists expedited involvement of hyperbaric medicine is required for improved outcomes.