A Case of Pneumocephalus Due to an Untreated Atrial-Esophageal Fistula Post-Left Atrial Ablation Therapy

Air embolisms can be caused by trauma, barotrauma, or due to surgical procedures in neurosurgery, vascular surgery, and cardiac surgery. An atrial-esophageal fistula (AEF) is a life-threatening complication that can occur following left atrial ablation therapy, which is used to treat refractory atrial fibrillation (Afib). AEF, if left untreated, can lead to serious neurological complications such as pneumocephalus. We present a rare case of pneumocephalus in a 60-year-old male who recently underwent left atrial ablation therapy after which he presented to the ER following a fall. On examination, the patient was confused and had difficulty getting up. A left hemiparesis and a rightward gaze preference were also observed. The CT scan of the head confirmed pneumocephalus. Our report is unique as it explores a very rare entity and highlights the implications of a delay in the treatment of AEF. Early surgical intervention is the key to ensuring the survival of patients with an AEF.