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Spontaneous cerebral gas embolism and pulmonary arteriovenous malformation: a case report

Nicole P Harlan, Laura H Davies, Lindell K Weaver

    Undersea & Hyperbaric Medicine : Journal of the Undersea and Hyperbaric Medical Society, Inc
    |November 24, 2015
    PubMed

    Insights

    Cerebral arterial gas embolism (CAGE) can occur from pulmonary barotrauma. This case highlights how an undiagnosed pulmonary arteriovenous malformation and obstructive sleep apnea contributed to CAGE.

    Area of Science:

    • Neurology
    • Pulmonology
    • Radiology

    Background:

    • Pulmonary barotrauma can lead to cerebral arterial gas embolism (CAGE).
    • Occult pulmonary arteriovenous malformation (PAVM) and obstructive sleep apnea (OSA) are potential contributing factors.

    Observation:

    • A 46-year-old male presented with seizures and left-sided weakness.
    • Brain CT revealed gas emboli; Chest CT identified a PAVM.
    • Transthoracic echocardiogram excluded intracardiac shunts.

    Findings:

    • The patient was diagnosed with CAGE secondary to an occult PAVM and severe OSA.
    • Treatment included medical management, PAVM embolization, and CPAP for OSA.
    • The patient recovered fully and remained asymptomatic at seven-year follow-up.

    Implications:

    • High negative intrathoracic pressure during OSA may cause air entrainment into PAVMs, leading to CAGE.
    • Early diagnosis and management of PAVMs and OSA are crucial for preventing CAGE.
    • This case underscores the importance of considering PAVMs and OSA in patients with unexplained CAGE.

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