scholarly journals Air bubbles in the brain: retrograde venous gas embolism in the cavernous sinus

2020 ◽  
Vol 15 (7) ◽  
pp. 1011-1013
Author(s):  
S. Allioui ◽  
S. Zaimi ◽  
S. Sninate ◽  
M. Abdellaoui
2019 ◽  
pp. 673-683
Author(s):  
Richard E. Moon ◽  

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac “vapor lock” and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence-based review of adjunctive therapies is presented.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mira Puthettu ◽  
Stijn Vandenberghe ◽  
Stefanos Demertzis

Abstract Background During cardiac surgery, micro-air emboli regularly enter the blood stream and can cause cognitive impairment or stroke. It is not clearly understood whether the most threatening air emboli are generated by the heart-lung machine (HLM) or by the blood-air contact when opening the heart. We performed an in vitro study to assess, for the two sources, air emboli distribution in the arterial tree, especially in the brain region, during cardiac surgery with different cannulation sites. Methods A model of the arterial tree was 3D printed and included in a hydraulic circuit, divided such that flow going to the brain was separated from the rest of the circuit. Air micro-emboli were injected either in the HLM (“ECC Bubbles”) or in the mock left ventricle (“Heart Bubbles”) to simulate the two sources. Emboli distribution was measured with an ultrasonic bubble counter. Five repetitions were performed for each combination of injection site and cannulation site, where air bubble counts and volumes were recorded. Air bubbles were separated in three categories based on size. Results For both injection sites, it was possible to identify statistically significant differences between cannulation sites. For ECC Bubbles, axillary cannulation led to a higher amount of air bubbles in the brain with medium-sized bubbles. For Heart Bubbles, aortic cannulation showed a significantly bigger embolic load in the brain with large bubbles. Conclusions These preliminary in vitro findings showed that air embolic load in the brain may be dependent on the cannulation site, which deserves further in vivo exploration.


1997 ◽  
Vol 85 (6) ◽  
pp. 1367-1371 ◽  
Author(s):  
Claude Mann ◽  
Gilles Boccara ◽  
Veronique Grevy ◽  
Francis Navarro ◽  
Jean M. Fabre ◽  
...  

2011 ◽  
Vol 112 (2) ◽  
pp. 401-409 ◽  
Author(s):  
A. Møllerløkken ◽  
S. E. Gaustad ◽  
M. B. Havnes ◽  
C. R. Gutvik ◽  
A. Hjelde ◽  
...  

PEDIATRICS ◽  
1990 ◽  
Vol 85 (4) ◽  
pp. 593-594
Author(s):  
WAYNE R. RACKOFF ◽  
DAVID F. MERTON

Gas embolism to the portal venous system is a well-recognized radiographic sign in infants with necrotizing enterocolitis. It also has been seen after colonic irrigation with hydrogen peroxide solution.1,2 We present what we believe is the first reported patient with radiographic evidence of portal venous gas embolism after ingestion of hydrogen peroxide solution. This finding is important because gas embolism to the portal venous system after colonic irrigation with hydrogen peroxide has been associated with gangrenous and perforated bowel.1,2 CASE REPORT A 2-year-old boy ingested an unknown amount of 3% hydrogen peroxide solution. The child was found with foam around his mouth.


Anaesthesia ◽  
1996 ◽  
Vol 51 (11) ◽  
pp. 683-684
Author(s):  
S. P. W. Neff ◽  
L. Zulueta ◽  
R. Miller

2013 ◽  
Vol 114 (5) ◽  
pp. 602-610 ◽  
Author(s):  
Nico A. M. Schellart ◽  
Tjeerd P. van Rees Vellinga ◽  
Rob A. van Hulst

For over a century, studies on body fat (BF) in decompression sickness and venous gas embolism of divers have been inconsistent. A major problem is that age, BF, and maximal oxygen consumption (V̇o2max) show high multicollinearity. Using the Bühlmann model with eight parallel compartments, preceded by a blood compartment in series, nitrogen tensions and loads were calculated with a 40 min/3.1 bar (absolute) profile. Compared with Haldanian models, the new model showed a substantial delay in N2 uptake and (especially) release. One hour after surfacing, an increase of 14–28% in BF resulted in a whole body increase of the N2 load of 51%, but in only 15% in the blood compartment. This would result in an increase in the bubble grade of only 0.01 Kisman-Masurel (KM) units at the scale near KM = I−. This outcome was tested indirectly by a dry dive simulation (air breathing) with 53 male divers with a small range in age and V̇o2max to suppress multicollinearity. BF was determined with the four-skinfold method. Precordial Doppler bubble grades determined at 40, 80, 120, and 160 min after surfacing were used to calculate the Kisman Integrated Severity Score and were also transformed to the logarithm of the number of bubbles/cm2 (logB). The highest of the four scores yielded logB = −1.78, equivalent to KM = I−. All statistical outcomes of partial correlations with BF were nonsignificant. These results support the model outcomes. Although this and our previous study suggest that BF does not influence venous gas embolism (Schellart NAM, van Rees Vellinga TP, van Dijk FH, Sterk W. Aviat Space Environ Med 83: 951–957, 2012), more studies with different profiles under various conditions are needed to establish whether BF remains (together with age and V̇o2max) a basic physical characteristic or will become less important for the medical examination and for risk assessment.


2009 ◽  
Vol 61 (5) ◽  
pp. 318-318 ◽  
Author(s):  
Philipp Zickler ◽  
Hans-Peter Hartung ◽  
Hendrik Janssen

2010 ◽  
Vol 10 (02) ◽  
pp. 361-372 ◽  
Author(s):  
SHENGXIONG LIU ◽  
ZHIYONG YIN ◽  
HUI ZHAO ◽  
GUANGYU YANG

In this paper, a transparent physical head model with air bubbles to simulate the brain cavitation phenomena in head decelerating impact is presented. The transparent skull model was generated based on a real human skull through the turnover formwork technique, and a transparent gel was used to substitute the brain tissue. Air bubbles were created in the gel at the representative sites such as coup site and contrecoup site. After this, the head model was made to free fall from a position and impact on a fixed platform. The decelerating impacting process was recorded by a high-speed video camera and an accelerometer system. Through analyzing the video, the volume change of the air bubbles, namely, the mean pressure change of the air bubbles were calculated and compared. This new method has an advantage in investigating the brain cavitation phenomena using a direct and visual technique. The results showed explicitly and effectively that during the decelerating impact the contrecoup site air bubble was exposed mainly to a negative pressure which value became smaller and smaller in the first half of the impacting cycle and then came near to the normal level in the second half of the cycle; contrarily, the coup site air bubble was exposed mainly to a positive pressure which value became greater and greater in the first half of the impacting cycle and then came near to the normal level in the second half cycle. The probable biomechanics of the cavitation phenomenon is also given in this paper.


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