Case Report: Cerebral air embolism following fluid–air exchange during pars plana vitrectomy: a rare but severe complication
- 1The First Affiliated Hospital of Hunan Traditional Chinese Medical College (Hunan Provincial Directly Affiliated Hospital of Traditional Chinese Medicine)
Abstract
Cerebral air embolism (CAE) is a rare but potentially life-threatening neurological emergency, typically caused by the inadvertent entry of exogenous air into the venous circulation and subsequent migration to the cerebral vasculature. It presents with abrupt onset and a prognosis that heavily depends on early recognition and prompt intervention. We report a case of CAE that occurred during pars plana vitrectomy (PPV) involving intraoperative fluid–air exchange. The patient experienced sudden ocular pain intraoperatively, followed shortly post-operatively by acute neurological symptoms including altered consciousness, ataxia, and slurred speech. Brain MRI using a standard stroke protocol, including DWI with b values of 0 and 1,000 s/mm ² and ADC maps, revealed multiple acute infarcts in the bilateral frontal, parietal, and occipital lobes, thalamus, and corpus callosum. DWI demonstrated widespread hyperintensity with corresponding ADC reduction. Although no definite intravascular air artifacts were detected, the combination of intraoperative pressure fluctuations, a hypercoagulable state, and elevated levels of D-dimer and cardiac troponin I strongly supported the diagnosis of CAE with possible concomitant microembolism-induced ischemia. The patient received prompt multidisciplinary intensive care and exhibited marked neurological recovery with favorable prognosis. This case highlights the need for high clinical suspicion of CAE during procedures involving air infusion, abrupt pressure changes, or vascular injury risk. Emergent neuroimaging and multidisciplinary management are critical to minimizing neurological sequelae and ensuring patient safety.
Related
- Visual outcomes and headache in intracranial hypertension following cerebral venous sinus thrombosis: A retrospective cohort study
- Complication rates of proximal hypospadias: meta-analyses of four surgical repairs
- Predictors of pulmonary embolism in chronic obstructive pulmonary diseases patients admitted for worsening respiratory symptoms: An individual participant data meta-analyses
- Genetic Associations with Pulmonary Embolism among Those with a Deep Vein Thrombosis: The INVENT Consortium
- Pentasystem embolism associated with transient antiphospholipid antibodies in severe M. pneumoniae pneumonia: a “Dual-Hit” case report and systematic review
BibTeX
@article{zhang2026case,
title = {{Case Report: Cerebral air embolism following fluid–air exchange during pars plana vitrectomy: a rare but severe complication}},
author = {Rong Zhang and Guo Wen and Zhenqun Zhang},
journal = {Frontiers in Neuroscience},
year = {2026},
month = oct,
doi = {10.3389/fnins.2026.1929675},
url = {https://www.frontiersin.org/articles/10.3389/fnins.2026.1929675/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Cerebral air embolism following fluid–air exchange during pars plana vitrectomy: a rare but severe complication
AU - Rong Zhang
AU - Guo Wen
AU - Zhenqun Zhang
PY - 2026
DA - 2026/10/26
JO - Frontiers in Neuroscience
DO - 10.3389/fnins.2026.1929675
UR - https://www.frontiersin.org/articles/10.3389/fnins.2026.1929675/full
AB - Cerebral air embolism (CAE) is a rare but potentially life-threatening neurological emergency, typically caused by the inadvertent entry of exogenous air into the venous circulation and subsequent migration to the cerebral vasculature. It presents with abrupt onset and a prognosis that heavily depends on early recognition and prompt intervention. We report a case of CAE that occurred during pars plana vitrectomy (PPV) involving intraoperative fluid–air exchange. The patient experienced sudden ocular pain intraoperatively, followed shortly post-operatively by acute neurological symptoms including altered consciousness, ataxia, and slurred speech. Brain MRI using a standard stroke protocol, including DWI with b values of 0 and 1,000 s/mm ² and ADC maps, revealed multiple acute infarcts in the bilateral frontal, parietal, and occipital lobes, thalamus, and corpus callosum. DWI demonstrated widespread hyperintensity with corresponding ADC reduction. Although no definite intravascular air artifacts were detected, the combination of intraoperative pressure fluctuations, a hypercoagulable state, and elevated levels of D-dimer and cardiac troponin I strongly supported the diagnosis of CAE with possible concomitant microembolism-induced ischemia. The patient received prompt multidisciplinary intensive care and exhibited marked neurological recovery with favorable prognosis. This case highlights the need for high clinical suspicion of CAE during procedures involving air infusion, abrupt pressure changes, or vascular injury risk. Emergent neuroimaging and multidisciplinary management are critical to minimizing neurological sequelae and ensuring patient safety.
SN - 1662-453X
SN - 1662-4548
ER -