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Case report
peer-reviewed

Cerebral Air Embolism as Possible Cause of Stroke During Therapeutic Endobronchial Application of Argon Plasma Coagulation



Abstract

A 68-year-old male was admitted for evaluation of an endobronchial mass obstructing the right middle lobe (RML) and right lower lobe (RLL) of the lung. Flexible bronchoscopy revealed a notable endobronchial lesion in the bronchus intermedius that completely obstructed the RML and the RLL. Argon plasma coagulation (APC) at 30 watts and gas flow at 0.8 liters/minute to 1 liter/minute were applied to the tumor. In the recovery room, the patient was discovered to have a left-sided facial droop and left-sided weakness. The initial computed tomography (CT) scan of the brain and an angiogram of the head and neck were normal, but a repeat CT scan of the head several hours later was remarkable for an area of hypoattenuation in the right frontoparietal lobe concerning for infarct. A magnetic resonance imaging (MRI) brain scan confirmed acute to sub-acute cortical infarcts. Given the direct temporal relation between the onset of neurologic symptoms and the usage of APC with bronchoscopy, a cerebral air embolism (CAE) was thought to be the cause of the patient’s acute stroke.



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Case report
peer-reviewed

Cerebral Air Embolism as Possible Cause of Stroke During Therapeutic Endobronchial Application of Argon Plasma Coagulation


Author Information

Venkatkiran Kanchustambham Corresponding Author

Pulmonary and Critical Care, Sanford Health Care, University of North Dakota

Manasa Reddy

General Internal Medicine, Saint Louis University School of Medicine

Swetha Saladi

Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine

Setu Patolia

Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Cerebral Air Embolism as Possible Cause of Stroke During Therapeutic Endobronchial Application of Argon Plasma Coagulation


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Case report
peer-reviewed

Cerebral Air Embolism as Possible Cause of Stroke During Therapeutic Endobronchial Application of Argon Plasma Coagulation

  • Author Information
    Venkatkiran Kanchustambham Corresponding Author

    Pulmonary and Critical Care, Sanford Health Care, University of North Dakota

    Manasa Reddy

    General Internal Medicine, Saint Louis University School of Medicine

    Swetha Saladi

    Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine

    Setu Patolia

    Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: May 17, 2017

    DOI

    10.7759/cureus.1255

    Cite this article as:

    Kanchustambham V, Reddy M, Saladi S, et al. (May 17, 2017) Cerebral Air Embolism as Possible Cause of Stroke During Therapeutic Endobronchial Application of Argon Plasma Coagulation. Cureus 9(5): e1255. doi:10.7759/cureus.1255

    Publication history

    Received by Cureus: April 28, 2017
    Peer review began: May 04, 2017
    Peer review concluded: May 09, 2017
    Published: May 17, 2017

    Copyright

    © Copyright 2017
    Kanchustambham et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A 68-year-old male was admitted for evaluation of an endobronchial mass obstructing the right middle lobe (RML) and right lower lobe (RLL) of the lung. Flexible bronchoscopy revealed a notable endobronchial lesion in the bronchus intermedius that completely obstructed the RML and the RLL. Argon plasma coagulation (APC) at 30 watts and gas flow at 0.8 liters/minute to 1 liter/minute were applied to the tumor. In the recovery room, the patient was discovered to have a left-sided facial droop and left-sided weakness. The initial computed tomography (CT) scan of the brain and an angiogram of the head and neck were normal, but a repeat CT scan of the head several hours later was remarkable for an area of hypoattenuation in the right frontoparietal lobe concerning for infarct. A magnetic resonance imaging (MRI) brain scan confirmed acute to sub-acute cortical infarcts. Given the direct temporal relation between the onset of neurologic symptoms and the usage of APC with bronchoscopy, a cerebral air embolism (CAE) was thought to be the cause of the patient’s acute stroke.



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Venkatkiran Kanchustambham, M.D., Assistant Professor

Pulmonary and Critical Care, Sanford Health Care, University of North Dakota

For correspondence:
vkanchus@slu.edu

Manasa Reddy

General Internal Medicine, Saint Louis University School of Medicine

Swetha Saladi

Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine

Setu Patolia, M.D., Assistant Professor

Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine

Venkatkiran Kanchustambham, M.D., Assistant Professor

Pulmonary and Critical Care, Sanford Health Care, University of North Dakota

For correspondence:
vkanchus@slu.edu

Manasa Reddy

General Internal Medicine, Saint Louis University School of Medicine

Swetha Saladi

Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine

Setu Patolia, M.D., Assistant Professor

Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine