Cerebral and Systemic Infarcts After Bronchial Artery Embolization

• Published in: Pediatric neurology 2011-11, Vol.45 (5), p.324-327
• Main Authors: Pestana Knight, Elia M., MD, Novelli, Paula M., MD, Joshi, Sucheta M., MD, MS
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Bronchial Arteries - pathology; Cerebral Infarction - diagnosis; Cerebral Infarction - etiology; Cystic Fibrosis - therapy; Embolization, Therapeutic - adverse effects; Female; Humans; Infarction - diagnosis; Infarction - etiology; Medical sciences; Neurology; Pediatrics; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2011.08.012

Abstract Bronchial artery embolization with microspheres constitutes an effective, safe procedure for controlling hemoptysis. A 17-year-old girl with cystic fibrosis developed hemoptysis and underwent bilateral bronchial artery embolization with 300-500 μm and 500-700 μm microsphere particles. Afterward, she was delirious and complained of headache. On initial examination, she manifested altered mental status and diffuse hyperreflexia. Her left fifth digit was painful and cyanotic. Neuroimaging demonstrated multiple embolic infarcts in the cerebellum, thalamus, and cerebral hemispheres. An echocardiogram produced normal results. An evaluation of her thrombophilia revealed heterozygosity for a prothrombin 20210A mutation. Her functional neurologic recovery was complete. To our knowledge, this is the first pediatric case of cerebral and systemic embolism after bronchial artery embolization. Although this complication is not predictable, it should be suspected in patients with underlying chronic lung disease who develop acute neurologic signs after bronchial artery embolization, because these patients are prone to anomalous arterial-arterial shunt formation.