A Case of Cerebral Air Embolism After Dental Procedure

• Published in: Curēus (Palo Alto, CA) Vol. 15; no. 2; p. e34976
• Main Authors: David, Filipa, Castedo, João S, Prisco, Inês, França, Sara, Gonçalves, Celina, Monteiro, Sofia
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 14-02-2023; Cureus
• Subjects: Anesthesiology; Case reports; Coma; Consciousness; Emergency medical care; Emergency Medicine; Hemodynamics; Intensive care; Local anesthesia; Magnetic resonance imaging; Medical imaging; Neurology; Oxygen therapy; Pulmonary embolisms; hyperbaric oxygen therapy; super-refractory status epilepticus; cerebral air embolism; dental procedure; coma
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.34976

Air embolism is a rare and life-threatening event that occurs when air enters the cardiovascular system, usually secondary to iatrogenic vascular procedures. We present a 58-year-old woman who underwent a dental procedure (devitalization of a tooth) under local anesthesia, with a sudden onset of coma during manipulation and documentation of air in the vessels of the right frontal convexity sulci. After cerebral air embolism was confirmed, she received hyperbaric oxygen therapy, with resorption of the gas, but clinically she developed a super-refractory status epilepticus with a persistent coma. The slow clinical course required the exclusion of other etiologies of coma. The pathophysiology is not well known; however, it appears to be related to the injection of air by the high-speed dental drill through the soft tissue adjacent to the roots of the teeth, nearby the bloodstream. We highlight this event because of this unlikely association, which may delay diagnosis and the good results of hyperbaric medicine on prognosis.