J Cerebrovasc Endovasc Neurosurg.  2014 Jun;16(2):93-97. 10.7461/jcen.2014.16.2.93.

Symptomatic Cerebral Air Embolism During Stent-assisted Coiling of an Unruptured Middle Cerebral Artery Aneurysm: Intraoperative Diagnosis and Management of a Rare Complication

• Tan LA
• Keigher KM
• Lopes DK

• KMID: 1963176
• DOI: http://doi.org/10.7461/jcen.2014.16.2.93

Abstract

Symptomatic cerebral air embolism during cerebral angiography is extremely rare. We report on the case of a 69-year-old woman undergoing elective stent-assisted coiling of an unruptured right middle cerebral artery (MCA) bifurcation aneurysm, who was found to have severe attenuation of somatosensory evoked potential (SSEP) and electroencephalography (EEG) during the procedure. Intra-operative DynaCT showed hypodense cortical vessels consistent with cerebral air embolism. Diagnostic and management strategies for this rare complication are reviewed.

Keyword

Cerebral air embolism; Cerebral angiography

MeSH Terms

Aged
Aneurysm
Cerebral Angiography
Diagnosis*
Electroencephalography
Embolism, Air*
Evoked Potentials, Somatosensory
Female
Humans
Intracranial Aneurysm*
Middle Cerebral Artery

Figure

• 

  Fig. 1 Intraoperative DynaCT showing air emboli outlining cortical vessels with air serving as a negative contrast medium.

• 

  Fig. 2 Post-procedural magnetic resonance imaging showing only a small focal area with restricted diffusion in the right parietal region.

• 

  Fig. 3 (A) Pre-procedural cerebral angiogram showing the 7 mm right middle cerebral artery bifurcation aneurysm with complex morphology. (B) Follow-up cerebral angiogram showing a Raymond grade 1 occlusion of the aneurysm.

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