Gas in the Brain: A Case of Cerebral Arterial Gas Embolism

Arterial gas embolism is a rare complication of several percutaneous procedures, including lung biopsy, and can lead to debilitating and deadly consequences for patients when not treated promptly.

A 67-year-old woman who had a history of a lung nodule underwent percutaneous lung biopsy with interventional radiology. She tolerated the procedure well, but shortly afterwards developed profound left neglect and hemiparesis. Computed tomography imaging was negative, and the patient was suspected to have developed an arterial gas embolism secondary to her procedure. She was intubated for airway protection after multiple seizures (prior to intubation, patient was not placed on supplemental oxygen in the emergency department) and was transferred to a facility capable of performing hyperbaric treatment, which she underwent. However, her brain damage was significant, with subsequent imaging showing significant cerebral edema, and she was eventually made palliative and passed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Cerebral arterial gas embolism (CAGE) is a high acuity, low-occurrence event, where outcomes are predicated on early treatment that includes 100% supplemental oxygen delivered via non-rebreather and hyperbaric treatment. To facilitate early treatment, emergency physicians must recognize CAGE as an entity and the circumstances under which it might occur.