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Case Report

Ischaemic Stroke of the “Hand-Knob” Area Due to Paradoxical Cerebral Air Embolism after Central Venous Catheterization—A Doubly Rare Occurrence: A Case Report and an Overview of Pathophysiology, Diagnosis, and Treatment

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Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Neurodegenerative Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Cardiovascular Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Department of Neuroradiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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Author to whom correspondence should be addressed.
Academic Editor: Jan Brogger
Brain Sci. 2022, 12(6), 772; https://doi.org/10.3390/brainsci12060772
Received: 25 April 2022 / Revised: 2 June 2022 / Accepted: 10 June 2022 / Published: 13 June 2022
(This article belongs to the Section Neurosurgery and Neuroanatomy)
Central venous catheters (CVCs) are increasingly used across specialties for invasive haemodynamic monitoring and for the delivery of fluids, medications, and nutritional support. Cerebral air embolism (CAE) is a rare but potentially fatal complication associated with the insertion, maintenance, and removal of CVCs. It can occur through different mechanisms, including the direct retrograde ascension of air into the cerebral veins and paradoxical embolism due to a right-to-left intracardiac or intrapulmonary shunt. The “hand-knob” area is the cortical region within the primary motor cortex that contains the representation of the hand. It is located in the superior precentral gyrus and is the site of less than 1% of all ischaemic strokes. We report here the case of a patient who experienced an ischaemic stroke of the right “hand-knob” area, due to paradoxical CAE through a previously undiagnosed patent foramen ovale (PFO), after the insertion of a catheter in the right internal jugular vein. We also provide an overview of the pathophysiology, diagnosis, and treatment of CAE. Suspecting CAE in the case of an acute neurological event occurring in close temporal relationship with central venous catheterization is paramount to allow the early recognition and treatment of this uncommon form of iatrogenic stroke. View Full-Text
Keywords: central venous catheterization; cerebral air embolism; hand-knob; iatrogenic stroke; ischaemic stroke; paradoxical embolization; patent foramen ovale central venous catheterization; cerebral air embolism; hand-knob; iatrogenic stroke; ischaemic stroke; paradoxical embolization; patent foramen ovale
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MDPI and ACS Style

Nicolini, P.; Arighi, A.; Gherbesi, E.; Lo Russo, F.M.; Mandelli, C.; Schinco, G.; Carugo, S.; Lucchi, T. Ischaemic Stroke of the “Hand-Knob” Area Due to Paradoxical Cerebral Air Embolism after Central Venous Catheterization—A Doubly Rare Occurrence: A Case Report and an Overview of Pathophysiology, Diagnosis, and Treatment. Brain Sci. 2022, 12, 772. https://doi.org/10.3390/brainsci12060772

AMA Style

Nicolini P, Arighi A, Gherbesi E, Lo Russo FM, Mandelli C, Schinco G, Carugo S, Lucchi T. Ischaemic Stroke of the “Hand-Knob” Area Due to Paradoxical Cerebral Air Embolism after Central Venous Catheterization—A Doubly Rare Occurrence: A Case Report and an Overview of Pathophysiology, Diagnosis, and Treatment. Brain Sciences. 2022; 12(6):772. https://doi.org/10.3390/brainsci12060772

Chicago/Turabian Style

Nicolini, Paola, Andrea Arighi, Elisa Gherbesi, Francesco Maria Lo Russo, Clara Mandelli, Giuseppina Schinco, Stefano Carugo, and Tiziano Lucchi. 2022. "Ischaemic Stroke of the “Hand-Knob” Area Due to Paradoxical Cerebral Air Embolism after Central Venous Catheterization—A Doubly Rare Occurrence: A Case Report and an Overview of Pathophysiology, Diagnosis, and Treatment" Brain Sciences 12, no. 6: 772. https://doi.org/10.3390/brainsci12060772

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