PMID- 28607332
OWN - NLM
STAT- MEDLINE
DCOM- 20171201
LR  - 20190609
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 18
DP  - 2017 Jun 13
TI  - Massive Ischemic Stroke Due to Pulmonary Barotrauma and Cerebral Artery Air 
      Embolism During Commercial Air Travel.
PG  - 660-664
AB  - BACKGROUND Air embolism into the systemic arterial circulation secondary to 
      pulmonary barotrauma has rarely been reported. Herein, we report the clinical 
      course of an extremely rare presentation of cerebral air embolism likely due to 
      ruptured pulmonary bullae during commercial air travel. CASE REPORT A 65-year-old 
      man suddenly became unconscious during an airplane descent. Upon landing, he was 
      immediately transferred to the nearest emergency department where he was 
      intubated for airway protection. His head CT angiogram showed multiple air 
      pockets in the right parietal lobe suspicious for multiple air emboli. His chest 
      CT scan showed multiple large bullae in the left upper and lower lobes as well as 
      diffusely emphysematous lung tissue. After initial stabilization, he underwent 
      emergent hyperbaric oxygen treatment (HBOT) in the multiplace chamber at 2.8 
      atmospheres. The patient tolerated HBOT well with no complications. However, his 
      neurologic status deteriorated in the following 24 hours due to progression of 
      his cerebral edema and mass effects. The patient's clinical status was discussed 
      with his family and the decision was made to withdraw life-sustaining measures. 
      He died shortly after withdrawal of life support. Post-mortem examination 
      confirmed the presence of very large bullae in the lungs bilaterally. CONCLUSIONS 
      Spontaneous cerebral air embolism is a possible complication of ruptured 
      pulmonary bullae during air travel. HBOT is well-tolerated and may be used with 
      caution even in the presence of emphysematous bullae.
FAU - Farshchi Zarabi, Sara
AU  - Farshchi Zarabi S
AD  - Department of Medicine, University of Toronto, Toronto, ON, Canada.
FAU - Parotto, Matteo
AU  - Parotto M
AD  - Department of Anesthesiology, University of Toronto, Toronto, ON, Canada.
FAU - Katznelson, Rita
AU  - Katznelson R
AD  - Department of Anesthesiology, University of Toronto, Toronto, ON, Canada.
FAU - Downar, James
AU  - Downar J
AD  - Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, 
      Canada.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20170613
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
SB  - IM
MH  - Aged
MH  - Barotrauma/*complications
MH  - Brain Edema/etiology
MH  - Cerebral Arteries/*diagnostic imaging
MH  - Clinical Deterioration
MH  - Embolism, Air/diagnostic imaging/*etiology
MH  - Fatal Outcome
MH  - Humans
MH  - Lung Injury/*etiology
MH  - Male
MH  - Stroke/*etiology
MH  - *Travel-Related Illness
PMC - PMC5478217
COIS- Conflict of interest: None declared Conflict of interests No relevant conflict of 
      interests.
EDAT- 2017/06/14 06:00
MHDA- 2017/12/02 06:00
PMCR- 2017/06/13
CRDT- 2017/06/14 06:00
PHST- 2017/06/14 06:00 [entrez]
PHST- 2017/06/14 06:00 [pubmed]
PHST- 2017/12/02 06:00 [medline]
PHST- 2017/06/13 00:00 [pmc-release]
AID - 903354 [pii]
AID - 10.12659/ajcr.903354 [doi]
PST - epublish
SO  - Am J Case Rep. 2017 Jun 13;18:660-664. doi: 10.12659/ajcr.903354.