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Glasgow Coma Scale score: 3. Gaze deviation to the left. Generalized hypotonia. Anisocoric pupils with right-sided mydriasis. Thoracic CT scan: small left apical pneumothorax and presence of ectopic air in the upper mediastinum (arrows) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Brain CT scan: presence of numerous air bubbles located in the cerebral sulci (arrows), and cortico-subcortical hypodense areas distributed in bilateral parieto-occipital regions (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). An intrapulmonary shunt would be mechanism involved that could explain our case (for the lack of a patent foramen ovale). A sudden increase of intrathoracic pressure due to Valsalva maneuvers, along with the development of pneumothorax and pneumomediastinum in a pathological lung could facilitate the passage of air into the pulmonary veins and from there into the left circulatory system causing cerebral air embolisms.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient’s prior written informed consent was obtained to be authorized to use the images in full compliance with the center regulations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 1002 "Tamanyo" => 172403 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1232 "Ancho" => 1250 "Tamanyo" => 106044 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004800000007/v1_202407021836/S2173572724000158/v1_202407021836/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004800000007/v1_202407021836/S2173572724000158/v1_202407021836/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724000158?idApp=WMIE" ]
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