Abstract Introduction Cerebral air embolism is a rare but potentially devastating iatrogenic event that can occur during invasive procedures, including dental interventions utilizing compressed air. Early recognition and supportive management are essential to prevent permanent neurological injury. We report a unique case of cerebral air embolism following a routine root canal procedure in a patient with prior thoracic surgery. Case Description A 63-year-old man with hypertension, hyperlipidemia, prediabetes, chronic kidney disease, cutaneous T-cell lymphoma in remission, and esophageal adenocarcinoma status post-total esophagectomy presented with acute-onset dizziness, visual obscurations, and right upper extremity weakness. Symptoms developed while compressed air was applied to the operative field during a routine root canal procedure.At presentation, he had right-sided weakness and facial droop. Non-contrast CT head was unremarkable, and CT angiography revealed no large vessel occlusion but suggested possible pulmonary air entry. Transthoracic echocardiogram showed normal biventricular function without intracardiac shunt. Brain MRI demonstrated restricted diffusion and FLAIR hyperintensity in the bilateral frontal lobes and sulcal regions, consistent with cerebral air embolism.He was transferred to a tertiary care neuro–intensive care unit for hyperbaric oxygen therapy (HBOT) evaluation however his neurological deficits had fully resolved, and given more than 24 hours since onset, HBOT was deferred. He was managed with high-flow oxygen, aspirin, and statin therapy. Repeat MRI showed no progression, and he was discharged at near-baseline functional status. Discussion This case highlights a rare instance of cerebral air embolism precipitated by a dental procedure. The mechanism likely involves pressurized air entering the venous circulation through disrupted mucosal or periapical tissues, with subsequent passage into cerebral vessels. In patients with altered thoracic anatomy—such as those with prior esophagectomy—abnormal venous return or reduced pulmonary filtration may facilitate paradoxical embolization even in the absence of an intracardiac shunt.Cerebral air embolism should be recognized as a potential complication of routine dental interventions involving compressed air. MRI often shows multifocal cortical diffusion restriction in multiple vascular territories, reflecting non-arterial distribution and supporting a diagnosis of air embolism. Clinicians should maintain a high index of suspicion for cerebral air embolism in patients developing acute neurological deficits during dental procedures using compressed air. Awareness among dental professionals regarding the risk of air embolization is crucial, especially in individuals with altered thoracic or vascular anatomy. This abstract is funded by: None
Gul et al. (Fri,) studied this question.