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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 57, Num. 2, 2009, pp. 227-228

Neurology India, Vol. 57, No. 2, March-April, 2009, pp. 227-228

Neuroimage

Massive cerebral air embolism in a preterm with fetal alcohol syndrome

Tai-Heng Chen1,2 , Yuh-Jyh Jong1,2 , Rei-Cheng Yang1 , San-Nan Yang2,3

1 Division of Pediatric Neurology,
2 Graduate Institute of Medicine, College of Medicine,
3 Division of Neonatology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Correspondence Address: Prof. San-Nan Yang, Division of Neonatology, Department of Pediatrics and Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 807. y520729@gmail.com

Date of Acceptance: 06-Mar-2009

Code Number: ni09072

PMID: 19439871

DOI: 10.4103/0028-3886.51311

A mother with history of alcoholism during pregnancy delivered a baby boy weighing 1660 gms at 33 th weeks of gestation. The baby had features of fetal alcoholic syndrome (FAS) in the form of facial dysmorphic features, bilateral optic atrophy, and sensorineural hearing loss. The baby was put on continuous positive airway pressure (CPAP) as he developed respiratory distress syndrome (RDS) with which he had improvement in his respiratory status. On the seventh day he developed focal clonic seizures with secondary generalization. Computerized tomography (CT) brain revealed disseminated air collection in both the cerebral hemispheres [Figure - 1] suggestive of cerebral air embolism (CAE). Review of other radiological investigations did not reveal any evidence of systemic air embolism. Repeat brain CT done two days later showed extensive bihemispherical infarcts [Figure - 2]. He was given supportive care and discharged on stabilization. At 3 months follow-up the child had profound developmental delay and intractable epilepsy.

Cerebral air emboli are often micro-emboli, however massive CAE with survival have been documented. [1],[2] CAE has been reported rarely in the neonates receiving positive pressure ventilation for RDS. [1],[3] Damaged pulmonary vascular integrity due to relatively higher pulmonary inflation pressure in RDS is supposed to facilitate the entry of air into systemic circulation, including the cerebral circulation. [1],[3] Recent studies suggest that prenatal exposure of the fetus to alcohol may have deleterious effect on the development of cerebral vasculature. [4] This baby had been exposed to alcohol during prenatal period. Whether such exposure had any possible role in the development of massive CAE in this baby is speculative. This theory is tempting and only neuropathological studies in FAS may through a light.

References

1.Oppermann HC, Wille L, Obladen M, Richter E. Systemic air embolism in the respiratory distress syndrome of the newborn. Pediatr Radiol 1979;8:139-45.  Back to cited text no. 1  [PUBMED]  
2.Yang CW, Yang BP. Massive cerebral arterial air embolism following arterial catheterization. Neuroradiology 2005;47:892-4.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Fenton TR, Bennett S, McIntosh N. Air embolism in ventilated very low birth weight infants. Arch Dis Child 1988;63:541-3.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Solonskii AV, Logvinov SV, Kutepova NA. Development of brain vessels in human embryos and fetuses in conditions of prenatal exposure to alcohol. Neurosci Behav Physiol 2008;38:373-6.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]

Copyright 2009 - Neurology India

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[ni09072f2.jpg] [ni09072f1.jpg]
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