Introduction: An arterial gas embolism is defined as the presence of air in the arterial circulation. This is an extremely rare cause of stroke that has been described in a multitude of clinical scenarios, generally related to iatrogenic processes. A clinical case is reported in which the arterial gas embolism occurred after a traumatic brain injury, and the most relevant aspects of diagnosis and aetiopathogenesis are reviewed.
Case report: We report the case of a 52-year-old woman with an open craniofacial wound resulting from an attack with an axe. The initial CT scan found fractures in the left zygomatic, sphenoidal and maxillary arches, as well as pneumocephalus in the cavernous sinuses and the right carotid canal. One hour later, the patient showed a neurological deficit in the right hemisphere, and so a new cranial computed tomography scan with multimodal vascular study was urgently requested, which revealed the mobilisation of the pneumocephalus and ruled out a large vessel arterial occlusion. A shunt study using transcranial Doppler and echocardiography showed the presence of a patent foramen ovale to be the cause of arteriovenous communication that justified an arterial gas embolism. The follow-up CT scan at 48 hours confirmed the appearance of a right parietal ischaemic lesion.
Conclusion: This case reflects the simultaneous presence of air in the arterial and venous circulation of the brain, as well as the peripheral communication through a patent foramen ovale. This production mechanism is poorly documented in the literature.
Title: Embolismo arterial gaseoso paradojico tras una herida incisa craneal directa.
Introduccion. El embolismo arterial gaseoso se define como la presencia de aire en la circulacion arterial. Se trata de una causa extremadamente rara de ictus que se ha descrito en multitud de escenarios clinicos, generalmente relacionados con procesos yatrogenos. Se aporta un caso clinico en el que el embolismo arterial gaseoso sucedio tras un traumatismo craneoencefalico, y se revisan los aspectos mas relevantes del diagnostico y la etiopatogenia. Caso clinico. Mujer de 52 años que presentaba herida incisa craneofacial tras una agresion con un hacha. La tomografia computarizada inicial objetivo fractura en los arcos cigomatico, esfenoidal y maxilar izquierdos, asi como neumoencefalo en los senos cavernosos y el canal carotideo derecho. Una hora mas tarde, la paciente mostro un deficit neurologico hemisferico derecho, por lo que se solicito de forma urgente una nueva tomografia computarizada craneal con estudio vascular multimodal, que objetivo la movilizacion del neumoencefalo y descarto una oclusion arterial de gran vaso. Un estudio de shunt mediante Doppler transcraneal y ecocardiografia comprobo la presencia de un foramen oval permeable como causa de comunicacion arteriovenosa que justificaba un embolismo arterial gaseoso. La tomografia computarizada de control a las 48 horas confirmo la aparicion de una lesion isquemica parietal derecha. Conclusion. En este caso queda reflejada la presencia simultanea de aire en la circulacion cerebral arterial y venosa y la comunicacion periferica a traves de un foramen oval permeable. Este mecanismo de produccion esta escasamente documentado en la bibliografia.