Document Detail


Acute neurological symptoms during hypobaric exposure: consider cerebral air embolism.
MedLine Citation:
PMID:  23156097     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Cerebral arterial gas embolism (CAGE) is well known as a complication of invasive medical procedures and as a risk in diving and submarine escape. In the underwater environment, CAGE is caused by trapped air, which expands and leads to lung vessel rupture when ambient pressure decreases during ascent. Pressure decrease also occurs during hypobaric activities such as flying and, therefore, CAGE may theoretically be a risk in hypobaric exposure. We reviewed the available literature on this subject. Identified were 12 cases of CAGE due to hypobaric exposure. Based on these cases, we discuss pathophysiology, diagnosis, and treatment of CAGE due to hypobaric exposure. The low and slow pressure decrease during most hypobaric activities (as opposed to diving) account for the low incidence of CAGE during these exposures and suggest that severe air trapping must be present to cause barotrauma. This is also suggested by the large prevalence of air filled cysts in the case reports reviewed. We recommend considering CAGE in all patients presenting with acute central neurological injury during or shortly after pressure decrease such as flying. A CT scan of head and chest should be performed in these patients. Treatment with hyperbaric oxygen therapy should be initiated as soon as possible in cases of proven or probable CAGE.
Authors:
Robert P Weenink; Markus W Hollmann; Robert A van Hulst
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Aviation, space, and environmental medicine     Volume:  83     ISSN:  0095-6562     ISO Abbreviation:  Aviat Space Environ Med     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501714     Medline TA:  Aviat Space Environ Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1084-91     Citation Subset:  IM; S    
Affiliation:
Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands vy, P.O. Box 10000, 1780 CA, Den Helder, The Netherlands. r.p.weenink@amc.nl
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