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Cortical Vein Air Emboli With Gyriform Infarcts

Daniel Lai, MD1; Tudor G. Jovin, MD1; Ashutosh P. Jadhav, MD, PhD1
[+] Author Affiliations
1Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA Neurol. 2013;70(7):939-940. doi:10.1001/jamaneurol.2013.1949.
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A 67-year-old man with stage III lung cancer complicated by lung abscesses was receiving fluid resuscitation for dehydration through a left subclavian port when he developed sudden onset of confusion and left-sided weakness. The patient gradually became less responsive, and a computed tomographic scan of the head demonstrated air in the cerebral veins (Figure, B) as well as incidental cerebral atrophy. A venous source was suspected, and a computed tomographic scan of the chest confirmed air in the right subclavian vein (Figure, A). The patient did not improve, despite receiving hyperbaric oxygen. Magnetic resonance imaging of the head demonstrated a gyriform pattern of ischemic changes (Figure, C) consistent with air emboli.1

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Computed Tomography of the Thorax and Head, and Magnetic Resonance Imaging

A, Computed tomographic scan of the thorax reveals air in the right subclavian vein (arrow). B, Computed tomographic scan of the head performed 80 minutes after symptom onset demonstrated air in the cerebral veins (arrows). C, Diffusion-weighted magnetic resonance imaging performed 17 hours later demonstrated cortical infarcts.

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