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Abstract Details

Rare Case of Cerebral Air Embolism After Hemodialysis
Cerebrovascular Disease and Interventional Neurology
P8 - Poster Session 8 (5:30 PM-6:30 PM)
Arterial air embolism can be fatal and early recognition can reduce mortality and morbidity. Air can block arterial flow leading to distal cortical ischemia and disrupting the blood brain barrier with endothelial irritation.  


A 61 year old right-handed Caucasian male with a history of CKD4, hypertension, protein C deficiency with prior PE/DVTs on apixiban presented with acute left sided weakness. The patient was recently diagnosed with ESRD and learning home hemodialysis. While undergoing teaching at dialysis, the patient coughed and the catheter cap was not completely closed, introducing air inline and the line uncapped briefly until nursing recapped the catheter. The patient became acutely symptomatic with shortness of breath and left hemibody weakness.

Initial imaging on arrival to the hospital showed cerebral air embolism with right MCA/ACA watershed ischemia and patient was placed in supine position. Repeat CTA head approximately 14 hours later showed resolution of air emboli, but new high convexity edema. MRI confirmed edema in the right frontal region with diffusion restriction in a sulcal pattern. The patient was treated with hyperosmolar therapy to correct hyponatremia. He also had subjective dyspnea, and nonrebreather was used. He developed near continuous myoclonus in the left lower extremity without EEG evidence of cortical myoclonus, which resolved with clonazepam. Patient also developed right pulmonary artery thrombus requiring anticoagulation, initially with heparin and discharged with apixaban.

Early recognition of cerebral air embolism is important when a patient is presenting with focal neurologic deficits as it is managed differently than acute stroke. In this case, history was essential to diagnosis in the setting of learning home hemodialysis and is not limited to patients hospitalized for medical procedures. Treatment is focused on supportive care, supine positioning for arterial embolism, and when available, hyperbaric oxygen therapy.
Edna M. Johnson, MD (Edna Johnson, MD)
Dr. Johnson has nothing to disclose.
Ramsha Farrukh, MD Dr. Farrukh has nothing to disclose.
Amita Singh, MD (University of Florida) Dr. Singh has nothing to disclose.