16 Mar

Pathogenesis of Cerebral Air Embolism during Neodymium-YAG Laser Photoresection: Hyperbaric treatments

Pathogenesis of Cerebral Air Embolism during Neodymium-YAG Laser Photoresection: Hyperbaric treatmentsThe patient was given dexamethasone (Decadron), 20 mg IVP, and 250 ml of 5 percent albumisol, while a GE-9800 head CT scan, performed without contrast material, was found to be unremarkable. A two-dimensional cardiac echocardiogram showed no thrombus or valvular lesions. A presumed diagnosis of acute air embolism was made. The patient was transferred via helicopter at a reduced altitude, receiving 100 percent 02, to a nearby hyperbaric center. He was treated initially with a US Navy Standard Table No. 6 (maximum depth of 60 ft, with a 1 ft/min ascent) approximately four hours after the event. It was thought that the preferred therapy for an air embolism, a Table No. 6A (maximum depth 165 ft), would be hazardous in view of the residual LLL obstruction and the risk of further embolization during the rapid ascent (26 ft/min) from 165 to 60 ft. Marked improvement in motor function was noted almost immediately on reaching 2.8 atm.

The patient received three additional hyperbaric treatments over the ensuing two days, with complete resolution of all motor defects and only subtle residual visual field defects. Magnetic resonance imaging (MRI) demonstrated two small defects in the region of the right frontal corona radiata appearing consistent with “lacunar infarctions.” Serial CPK enzymes increased to a maximum of472 U/L, however, were totally of the MM fraction. No further ECG abnormalities occurred. Additional laboratory values revealed a serum serotonin level of 129 ng/ml (normal: 50-175 ng/ml); 24-hour urine study for 5-hydroxyindoleacetic acid (5-HIAA) of 4.9 mg (normal;<16 mg/24 hr); am serum cortisol of 15.3 μg/dl (normal: 5 to 25 μ/dl); and serum gastrin level of 32 pg/ml (normal: 0 to 200 pg/ml).
The patient subsequently underwent a left pneumonectomy for what was determined on pathologic examination to be a malignant carcinoid tumor involving two carinal lymph nodes. There was no evidence of bronchial perforation on pathologic examination.

Categories: Air Embolism
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