A case of intracerebral air embolism following acupuncture

Recently, the reported causes of cerebral air embolism are more from invasive medical procedures than decompressive sickness. We report a patient with homolateral cerebral air embolism probably due to acupuncture to the anterior neck. A 64-year-old man was admitted with early seizure followed by unconsciousness and focal neurologic deficits. He had subcutaneous emphysema into the left anterior neck and chest wall. Several hours before admission, he underwent the acupuncture in the area of left anterior neck for the treatment of previous hemiplegia. Initial brain computed tomography (CT) showed multiple, small (2-8 mm in diameter) air bubbles in the corticomedullary junction area of the left cerebral hemisphere. He regained consciousness 2 days later. A delayed CT scan, taken 6 days after the event, showed no air bubbles in the cerebral hemisphere but massive cerebral edema. The patient's condition continued to improve during his hospital stay. He was discharged 3 weeks later with minimal neurologic deficits. Unilateral cerebral artery air embolism in this patient is thought to be caused by direct infiltration of air to the common carotid artery following acupuncture.