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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(12): 1
DOI: 10.1590/0004-282X-ANP-2021-0285
Articles

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

Pneumatose intracraniana: uma rara associação de embolismo gasoso cerebral e isquemia mesentérica
Igor Gomes PADILHA 
1   Santa Casa de São Paulo, Faculdade de Ciências Médicas, Departamento de Neuroradiologia, São Paulo SP, Brazil.
,
Helena Alves Costa PEREIRA 
2   Santa Casa de São Paulo, Faculdade de Ciências Médicas, Departamento de Imagem Torácica, São Paulo SP, Brazil.
,
Flávia Fajardo Linhares PEREIRA 
3   Hospital Risoleta Tolentino Neves, Departamento de Radiologia, Belo Horizonte MG, Brazil.
,
Sérgio ZACHARIAS  JUNIOR
3   Hospital Risoleta Tolentino Neves, Departamento de Radiologia, Belo Horizonte MG, Brazil.
,
Antônio José da ROCHA 
1   Santa Casa de São Paulo, Faculdade de Ciências Médicas, Departamento de Neuroradiologia, São Paulo SP, Brazil.
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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.

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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).

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Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

IGP, HACP, FFLP, SZJ, AJR: design or conceptualization of the study, analysis or interpretation of the data, drafting or revising the manuscript for intellectual content.


  • 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

Address for correspondence

Igor Gomes Padilha

Publication History

Received: 13 July 2021

Accepted: 21 July 2021

Article published online:
07 June 2023

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  • 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

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Zoom Image
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).