Case Notes
History
43 yo female presenting with acute neurological decline following bronchoscopy w/ cryotherapy for mets; presumed inadvertent IV air embolization.Exam
MR T2-w turbo spine echo and MR Flair sequencs
Prior Study
Noncontrast CT HeadAcute cytogenic edema involving the right anastomotic ACA-MCA border zone affecting both the overlying cortex as well as the subcortical white matter. Given the clinical context findings are likely related to CNS air embolization.
T1-w MR noncontrast only
Acute cytogenic edema involving the right anastomotic ACA-MCA border zone which includes the ACA-MCA cortex, as well as the subcortical white matter ACA-MCA watershed zone. Given the clinical context findings are likely related to CNS air embolization.
MR diffusion
Findings are consistent with air microembolization, which affects the cortex more than the underlying white matter, particularly in the right ACA-MCA anastomotic border, but to a lesser extent on the the left. The involvement of the cortex more than the white matter is consistent with stroke at the metarteriole-transcapillary level, which is a consistent feature of CNS microembolization. In this case wide areas are involved by the microembolic shower. However, in other cases microemboli cause very small strokes in the most distal terminal arterial branches, not infrequently involving the optic nerve or chiasm.