CASE REPORT   

Acta Phlebologica 2017 August;18(2):57-9

DOI: 10.23736/S1593-232X.17.00397-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Paradoxical embolism post-sclerotherapy using physiological gas

Elsy S. CALLE ✉, Daniel E. PULIDO, Jorge H. ULLOA

Section of Venous Diseases, Department of Vascular Surgery, Hospital Universitario Fundación Santa Fe, Bogotá, Colombia

Neurological and transient visual alterations associated with sclerotherapy have been described. It is known that the main cause of this phenomenon is the presence of a permeable oval foramen, whose prevalence in the general population is approximately 30%. Despite the above mentioned, most cases of paradoxical embolism are asymptomatic. We present a case of paradoxical embolism with fast recovery using physiological gas in a sclerotherapy. A 60-year-old woman, presented signs and symptoms of aphasia, severe headache, and changes in the behavior and motricity that occurred 15 minutes after sclerotherapy procedure with physiological gas, CO2/O2. She was taken to the emergency department where CT scan showed an air bubble in the territory of the parietal arterial branch of the middle cerebral artery and MRI confirmed compromise of the associated brain cortex. Non-rebreathing mask was ordered to maintain oxygen saturation at 100%. After 4 hours from the event, the patient presented almost complete improvement of her condition with total remission of the neurological deficit at 6 hours after the event. Echocardiogram confirmed the presence of a small permeable oval foramen. Paradoxical embolism post-sclerotherapy is a low incidence adverse effect, however, requires an early identification to provide prompt and adequate treatment. This case strengthens the recommendation to perform sclerotherapy with physiological gases such as CO2 or the combination of O2/CO2, since a better prognosis is associated when an adverse neurological event occurred.

KEY WORDS: Embolism, paradoxical - Sclerotherapy - Foramen ovale, patent