E2151. Benign to Catastrophic: A Case-Based Review of Cerebral Air Embolism
  1. Elena White; Uniformed Services University of The Health Sciences
  2. Horace Hayes; San Antonio Uniformed Services Health Education Consortium
  3. Paul Clark; San Antonio Uniformed Services Health Education Consortium
  4. Francis Cloran; San Antonio Uniformed Services Health Education Consortium
Cerebral air embolism (CAE) is a rare, yet potentially devastating condition characterized by entrance of air into cerebral vasculature. Cerebral air emboli are near uniformly iatrogenic in origin often following invasive procedures such as surgeries, endovascular procedures, and mechanical ventilation, among other etiologies. Presentation and severity of CAE ranges from subclinical to catastrophic in outcome. Symptoms of CAE may include acute mental status changes, stroke-like symptoms, or other encephalopathic symptoms, although some cases of venous CAE may be mild or subclinical. Increasing awareness of prevention, presentation, and treatment for CAE is crucial for reducing morbidity and mortality. In this educational exhibit, we highlight this rare, yet preventable entity by comparing three cases of CAE that showcase a diverse array of presentations, imaging findings, and clinical outcomes. We will also explore predisposing factors, prognostic predictors, key diagnostic considerations, and available treatments.

Educational Goals / Teaching Points
We will discuss a wide range of presentations of CAE ranging in severity from subclinical to catastrophic in outcome. We will highlight computed tomography (CT) imaging findings of both arterial and venous CAE, as well as select MRI correlates. We will review predisposing factors, diagnostic considerations, available treatment options, and prognostic indicators in CAE. We will discuss strategies to recognize common radiologic mimickers of CAE on CT imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Radiology plays a key role in identifying CAE. Rapid recognition of CAE diagnosis on CT imaging is crucial in initiating timely treatment and optimizing patient outcomes. The appearance of CAE on CT is characterized by air hypodensities in patterns correlating with intracerebral vasculature. The location and extent of these hypodensities vary; in this exhibit we will explore a range of CT imaging findings in cases of CAE. Magnetic resonance imaging (MRI) is not typically used to diagnose CAE but is a valuable tool in posttreatment evaluation and management. We will briefly discuss the correlation between initial CT and follow-up MRI findings in a case of arterial CAE.

Despite its rarity as an entity, the catastrophic potential of CAE demands continued investigation of treatment options and education regarding preventative measures. Advancing awareness of the wide range of possible CAE presentations and imaging findings, as well as commonly associated procedures and risk factors will aid in recognition and prompt diagnosis required to optimize patient outcomes.