Arterial cerebral air embolism at the site of a spontaneous pontine hemorrhage in a patient receiving erroneous continuous positive pressure ventilation

We report the case of a 48-year-old male with iatrogenic arterial cerebral air embolism at the site of a spontaneous pontine hemorrhage. The patient inadvertently received continuous positive pressure ventilation without exhalation for a few minutes, resulting in pneumothorax, interstitial emphysema, pneumoperitoneum, and arterial cerebral air embolism at the site of the intracerebral hemorrhage. This is the first report of pneumocephalus without head trauma or previous surgery in which the air embolism occurs at the site of a spontaneous intracerebral hemorrhage. We hypothesize that air preferentially leaked into the brain parenchyma through the weakened perforating pontine artery that caused the intracerebral bleeding.