Pulmonary barotrauma and cerebral arterial gas embolism during hyperbaric oxygen therapy

Hyperbaric oxygen therapy (HBOT) is used to treat a variety of disorders. It is a safe treatment modality, but rare catastrophic complications may occur. In this case report, we describe the occurrence of irreversible spastic quadriparesis in a patient who suffered a cerebral arterial gas embolism (CAGE) during decompression from HBOT. The patient had a history of respiratory disease and was subsequently found to have bullous changes in the left lung, which almost certainly predisposed to this rare event. We discuss appropriate pretreatment screening to prevent such events and highlight the paradox that HBOT, the cause of the CAGE, is also the treatment of choice.