Published Online
on August 2, 2007

A more recent version of this article appeared on September 1, 2007

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Submitted on January 28, 2007
Revised on March 25, 2007
Accepted on March 28, 2007

Cerebral Gas Embolism Caused by Pleural Fibrinolytic Treatment

Manuel Menéndez-González MD^*; Pedro Oliva-Nacarino MD; and Almudena Álvarez-Cofiño MD

From the Neurology Unit (M.M.G.), Hospital Álvarez-Buylla, Mieres, Oviedo, Spain; the Neurology Department (P.O.N.), Hospital Universitario Central de Asturias, Celestino Villamil, Asturias, Oviedo, Spain; and the Radiology Department (A.A.C.), Hospital Universitario Central de Asturias, Celestino Villamil, Asturias, Oviedo, Spain.

^* To whom correspondence should be addressed. E-mail: manuelmenendez{at}gmail.com.

Background and Purpose—Intrapleural fibrinolytic therapy is a technique used to treat empyemas and parapneumonic effusions. Cerebral air embolism is an unusual potentially severe complication of this technique.

Summary of Case—A patient with parapneumonic pleural effusion underwent pleural lavage with streptokinase when he suddenly demonstrated focal neurological signs and seizures. The CT revealed multiple air-isodense spots in right hemisphere of the brain, suggesting cerebral air embolism. As a result of early diagnosis and emergency hyperbaric oxygenation, the patient recovered without delayed sequelae.

Conclusions—Air embolism is a potentially severe complication which can occur during fibrinolytic pleural lavage, and clinicians should be aware of this risk. In this context, the onset of acute focal neurological signs or seizures should suggest the possibility of air embolism and lead to the transfer of the patient close to a hyperbaric facility within a few hours.

Key words: air embolism • fibrinolytic therapy • hyperbaric oxygenation • stroke

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