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NEUROIMAGE
Year : 2009  |  Volume : 57  |  Issue : 2  |  Page : 227-228

Massive cerebral air embolism in a preterm with fetal alcohol syndrome


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

Date of Acceptance06-Mar-2009

Correspondence Address:
San-Nan Yang
Division of Neonatology, Department of Pediatrics and Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, 807
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.51311

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How to cite this article:
Chen TH, Jong YJ, Yang RC, Yang SN. Massive cerebral air embolism in a preterm with fetal alcohol syndrome. Neurol India 2009;57:227-8

How to cite this URL:
Chen TH, Jong YJ, Yang RC, Yang SN. Massive cerebral air embolism in a preterm with fetal alcohol syndrome. Neurol India [serial online] 2009 [cited 2019 Dec 8];57:227-8. Available from: http://www.neurologyindia.com/text.asp?2009/57/2/227/51311


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 Top

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]


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  [Figure 1], [Figure 2]

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