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Neurological rarities
Fatal cerebral air embolism from atrio-oesophageal fistula following cardiac ablation
  1. Ryan Yann Shern Keh1,2,
  2. Daniel du Plessis3,
  3. Gillian M Potter4,5,
  4. Christopher Kobylecki1,5,
  5. Paul Cooper1,5
  1. 1 Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
  2. 2 MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
  3. 3 Department of Neuropathology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
  4. 4 Department of Neuroradiology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
  5. 5 University of Manchester, Manchester, UK
  1. Correspondence to Dr Ryan Yann Shern Keh, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK; ryan.keh2{at}nca.nhs.uk

Abstract

A young woman with Rogers syndrome (thiamine-responsive megaloblastic anaemia, diabetes mellitus and sensorineural deafness) presented with headache, recurrent supraventricular tachycardia and features of an upper gastrointestinal bleed, 1 month after radiofrequency cardiac ablation for supraventricular tachycardia. She deteriorated rapidly after endoscopy and subsequently died. Brain imaging during the acute deterioration showed diffuse intracranial air embolism and hypoxic–ischaemic injury. Postmortem examination showed an atrio-oesophageal fistula, a rare complication of cardiac ablation. Clinicians should suspect this condition in patients with acute neurological deterioration after cardiac ablation who have diffuse air embolism on imaging.

  • NEUROPATHOLOGY
  • MRI

Data availability statement

No data are available.

https://doi.org/10.1136/pn-2023-003915

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    Data availability statement

    No data are available.

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    Footnotes

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    • Contributors All authors were involved in the conceptualisation, design and revision of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Martin Punter, Otago, New Zealand.