Case report of a patient who developed a cerebral air embolism secondary to atrial-esophageal fistula

Carpeggiani P

NICHELLI, Paolo Frigio

Pinelli G

ZINI, Andrea

English

Archivio istituzionale della ricerca - Università di Modena e Reggio Emilia

IMAGES IN NEUROLOGYBrain Air Embolism Secondaryto Atrial-Esophageal FistulaA 44-YEAR-OLD MANwas admitted withseptic shock due toEscher i ch ia co l iinfection. His his-tory included myocardial infarc-tion and catheter ablation for anatrial flutter in 2004. During hishospitalization, he developed aprogressive reduction in his levelof consciousness to the point ofbecoming stuporous. Brain com-puted tomography showed exten-s i v e , m u l t i f o c a l a i r e m b o l i(Figure). Endoscopy documentedan atrial-esophageal fistula. Devel-opment of this fistula is a rare butsevere complication after catheterablation for atrial fibrillation sec-ondary to esophageal ulceration.1,2Afterward, he developed embolicstrokes and brain abscesses. Alltherapies given to the patient,including antibiotics, antithrom-botics, and fistula repair, did notimprove the condition.3,4 Thepatient died 3 months later.Published Online: February 27,2012. doi:10.1001/archneurol.2011.1896Author Affiliations: Stroke Unit,Neurology Clinic (Drs Zini andNichelli) and Neuroradiology Unit(Dr Carpeggiani), Department ofNeuroscience, University of Modenaand Reggio Emilia, and EmergencyDepartment (Dr Pinelli), Nuovo Os-pedale Civile “S. Agostino Estense”di Modena, Azienda Unità SanitariaLocale di Modena, Modena, Italy.Correspondence: Dr Zini, StrokeUnit, Neurology Clinic, Depart-ment of Neuroscience, Nuovo Os-pedale Civile “S. Agostino Estense”di Modena, Azienda Unità SanitariaLocale di Modena, via Giardini 1355,Modena 41100, Italy (andrea.zini@alice.it).Author Contributions: Study con-cept and design: Zini. Acquisition ofdata: Zini, Carpeggiani, and Pinelli.Analysis and interpretation of data:Zini, Carpeggiani, Pinelli, andNichelli. Drafting of the manuscript:Zini. Critical revision of the manu-script for important intellectual con-tent:Carpeggiani,Pinelli, andNichelli.Study supervision: Nichelli.Financial Disclosure: None re-ported.REFERENCES1. Dagres N, Anastasiou-Nana M. Prevention ofatrial-esophageal fistula after catheter ablation ofatrial fibrillation [published online November 19,2010]. Curr Opin Cardiol. doi:10.1097/HCO.0b013e328341387d.2. Grubina R, Cha YM, Bell MR, Sinak LJ, Asirva-tham SJ. Pneumopericardium following radiofre-quency ablation for atrial fibrillation: insights intothe natural history of atrial esophageal fistulaformation. J Cardiovasc Electrophysiol. 2010;21(9):1046-1049.3. Stöllberger C, Pulgram T, Finsterer J. Neurologi-cal consequences of atrioesophageal fistula afterradiofrequency ablation in atrial fibrillation. ArchNeurol. 2009;66(7):884-887.4. Finsterer J, Stöllberger C, Pulgram T. Neurologi-cal manifestations of atrio-esophageal fistulas fromleft atrial ablation. Eur J Neurol. 2011;18(10):1212-1219.Figure. Axial brain computed tomographic scans. Multiple and bilateral areas of decreased attenuationidentified intraparenchymal air pockets.Andrea Zini, MDPaolo Carpeggiani, MDGiovanni Pinelli, MDPaolo Nichelli, MD, PhDARCH NEUROL / VOL 69 (NO. 6), JUNE 2012 WWW.ARCHNEUROL.COM785©2012 American Medical Association. All rights reserved.Downloaded From: http://archneur.jamanetwork.com/ on 07/18/2012

Brain air embolism secondary to atrial-esophageal fistula.

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Brain air embolism secondary to atrial-esophageal fistula.

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Archivio istituzionale della ricerca - Università di Modena e Reggio Emilia