Retrograde cerebral venous air embolism and the anatomical pathway of air bubbles: a case report

Abstract

Pneumocephalus due to cerebral venous air embolism is an uncommon phenomenon. It results from retrograde progression of low weight air bubbles into dural venous sinuses during manipulation of a venous catheter, more frequently a central venous catheter through the subclavian and the jugular veins. However, it may also occur in relation with a peripheral intravenous catheter as in our case. We report a 91 year old female patient with congestive heart failure who had been examined in our emergency department two days previously due to dyspnea and received diuretic treatment through a peripheral intravenous line. She presented with vomiting and headache without obvious neurological deficits. Non-contrast cranial CT scan revealed wide spread punctate air bubbles inside and outside the cranial vault (pneumocephalus), within the venous system. The pneumocephalus was considered as iatrogenic due to the previous peripheral venous catheterization that resulted in retrograde migration of air bubbles through various venous connections into dural venous sinuses and extracranial veins. Since cerebral venous air embolism is a potentially serious complication of various medical procedures, it should be considered in differential diagnosis of nontraumatic headache and vomiting especially when there is a recent manipulation of venous lines. Cranial CT scan is helpful for early diagnosis.