Cerebral gas embolism and multifocal ischemic stroke during oxygen-ozone therapy: a case report
Introduction Ischaemic stroke, primarily caused by thromboembolic events, typically arises as a consequence of underlying vascular or cardiac pathology. Non-thrombotic embolic strokes, although rare, are increasingly seen in interventional and intravascular procedures. Oxygen-ozone therapy (OOT) is...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-12-01
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| Series: | BMJ Neurology Open |
| Online Access: | https://neurologyopen.bmj.com/content/6/2/e000885.full |
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| Summary: | Introduction Ischaemic stroke, primarily caused by thromboembolic events, typically arises as a consequence of underlying vascular or cardiac pathology. Non-thrombotic embolic strokes, although rare, are increasingly seen in interventional and intravascular procedures. Oxygen-ozone therapy (OOT) is one of the popular treatments for lumbar disc herniation, providing pain relief. However, it has been linked to gas embolisms, posing severe risks. This article details a case of cerebral gas embolism and multifocal acute ischaemic stroke that occurred during OOT for lumbar disc herniation pain relief.Case presentation We present a case of a 58-year-old woman with acute onset limb weakness and speech disturbance that happened during a lumbar intradiscal oxygen-ozone injection session. Brain CT and MRI scans showed multiple cerebral gas embolisms and diffusion-restricted areas in both cerebral hemispheres. Echocardiography revealed a patent foramen ovale, hinting at a conduit for paradoxical embolism. Follow-up of the patient after 1 year showed significant improvement.Conclusion OOT, as a popular treatment for chronic pain, has been associated with severe adverse events. When facing cases of acute postoperative or postinterventional encephalopathy or stroke, arterial cerebral gas embolism should be considered a possibility. The presence of intracardiac defects or intrapulmonary shunts paves the way for paradoxical emboli to happen, resulting in a higher chance of neurological complications. |
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| ISSN: | 2632-6140 |