303 - Rehabilitation of Multifocal Embolic Strokes Secondary to Air Emboli: A Case Report

Case Diagnosis: Air emboli are mostly iatrogenic in nature and are a rare yet dreaded complication following endoscopic procedures. Systemic arterial air emboli can occur with air entering via the pulmonary veins or directly into the arteries and then into the systemic circulation. The emboli can travel to the cerebrovascular and induce ischemic stroke.

Case Description:

A 69 year old female with history of stage IV adenocarcinoma of the lung presented to the ED as a stroke alert for persistent altered mental status after undergoing an outpatient bronchoscopy for a suspicious lung nodule. Imaging studies including CT head and CTA head & neck revealed pneumocephalus and scattered foci of gas. She was intubated and admitted to NICU and underwent one round of hyperbaric oxygen therapy (HBOT). Repeat CT imaging showed resolution of intracranial air but MRI brain showed infarcts in multiple vascular territories. She was admitted to an inpatient rehabilitation facility 1 week after her strokes requiring minimum assistance for transfers and gait and with moderate cognitive-linguistic deficits. She made functional gains during her admission progressing to a modified independent level for mobility with mild cognitive impairment.

Discussions: Stroke induced by iatrogenic air emboli is a rare complication that can occur following endoscopic procedures. Unlike traditional interventions such as thrombectomy, HBOT has been found to be beneficial for these patients. Even with HBOT, studies have shown a one-year mortality rates of 20% while others as high as 80% without intervention. Our case is notable for the etiology of, and the minimal deficits incurred from our patient’s strokes.

Conclusions: This case exhibits a rare cause of ischemic stroke induced by iatrogenic air emboli from bronchoscopy. Though rare, it should be part of the differential when working up persistent altered mental status post bronchoscopy. A comprehensive rehabilitation program can facilitate functional recovery after strokes secondary to air emboli