Cerebral air embolism via port catheter and endoscopic retrograde cholangio-pancreatography

BACKGROUND: Cerebral air embolism (CAE) is a critical clinical condition necessitating rapid diagnosis and therapeutic measures. METHODS: The authors describe two patients with lethal CAE. RESULTS: An 81-year-old man rapidly developed coma with tetraplegia. CT-scan revealed prominent CAE whereby the entry of the air was via a port catheter for parenteral nutrition. A 45-year-old man with severe alcohol-toxic multiple organ damage needed endoscopic retrograde cholangio-pancreatography (ERCP) and a second esophagogastroscopy. After an epileptic seizure, the CT-scan of the brain showed small amounts of cerebral air in the posterior right hemisphere and in the sagittal superior sinus. Despite critical care the patient died. CONCLUSION: CAE is a neurocritical emergency case. Early CT-scan of the brain can detect air, guide further therapy, and contribute to the assessment of the prognosis.