Pneumatosis intracranialis: a rare association of cerebral air embolism and mesenteric ischemia

Pneumatose intracraniana: uma rara associação de embolismo gasoso cerebral e isquemia mesentérica

A 67-year-old man presented with tetraparesis, which evolved rapidly into tetraplegia, and hyporeflexia and had decreased level of consciousness. Cranial and abdominal computed tomography (Figure 1) showed an intriguing association of mesenteric ischemia with pneumatosis intestinalis and intracranial air content in subarachnoid veins. This rarely reported association has been attributed to the ascension of air through the venous system when the central venous pressure is negative relative to the atmospheric pressure. It can trigger off a coagulation cascade resulting in impaired cerebral perfusion^1,2. The term pneumatosis intracranialis is herein proposed to describe this imaging abnormality in association with the description of air content in the bowel wall.

Figure 1.
Pneumatosis intracranialis: a rare association of cerebral air embolism and mesenteric ischemia. Cranial computed tomography (CT) showed linear air content fulfilling the subarachnoid veins of frontoparietal convexity (pneumatosis intracranialis) probably related with intracranial distribution after venous ascension (white arrows in A). Abdominal CT was also performed, showing air content in the portal venous system (dashed white arrow in B) in addition to pneumatosis intestinalis (black arrows in B).

References

• ¹
  Spanuchart I, Tamura A, Matsuda B, Leo QJ, Sung H. Cerebral venous air embolism secondary to mesenteric infarction. Hawaii J Med Public Health. 2016 May;75(5):133-6.
• ²
  Taydaş O, Onur MR, Akpınar E. Retrograde cerebral air embolism in a patient with intestinal necrosis: a case report. Balkan Med J. 2017 Aug;34(4):371-3. https://doi.org/10.4274/balkanmedj.2016.0292
  » https://doi.org/https://doi.org/10.4274/balkanmedj.2016.0292

Publication Dates

• Publication in this collection
  20 Sept 2021
• Date of issue
  Dec 2021

History

• Received
  13 July 2021
• Reviewed
  18 July 2021
• Accepted
  21 July 2021