ABSTRACT NUMBER: ESOC2026A746 CEREBRAL AIR EMBOLISM SECONDARY TO EXTRACARDIAC SHUNT AFTER LIVER RETRANSPLANTATION

Abstract Background and aims Describe an infrecuent cause of stroke secondary to cerebral air embolism (CAE) due to a probably paradoxical embolism through extracardiac shunt. Methods 65 year old man with history of type 2 diabetes mellitus and smoking and alcoholism, liver transplantation because of hepatocellular carinoma in 2023 and 2025. He was admitted in intensive care unit (UCI) due to hemorrhagic shock after liver retransplantation. During UCI admission, central venous access (CVA) was changed and presented a right-hemisphere stroke with NIHSS: 15. Results Multimodal CT evidenced a cortico-subcortical right-parietal hypodensity, air bubbles in cavernous sinus, superior sagital sinus and right-parietal convexity, altered perfusión maps in parietal región and lower diameter M2 vessel branches. MRI confirmed the presence of supratentorial and infratentorial bilateral but right predominant ischemic lesions. Study was completed with transcraneal ultrasound doppler with bubble test positive, highly suggestive of big right-left shunt and transesophageal echocardiography with normal result, which suggested extracardiac shunt. Control CT after two days evidenced parieto-temporal right and right-cerebellar established stroke. Conclusions CAE is an uncommon entity, but highly mortal, possibly produced by multiple mechanisms, being yatrogenic etiology the most frecuent; like vascular interventions, surgeries, trauma or diving. In our case we present a patient with chronic hepatopathy with retrasplantation, complications and use of CVA with recently replacement which leads to bilateral ischaemic stroke with right predominance, compatible with literatura by vascular anatomy, probably secondary to paradoxical embolism through extracardiac shunt. In this entity is essential to perform an early diagnosis to begin treatment to avoid a fatal outcome. Conflict of interest All of authors have nothing to disclose