Paradoxical embolism following intralesional sclerotherapy for cervical venous malformation.

Abstract

We present a rare case of a 47-year-old woman admitted to our maxillofacial surgery department for a large cervicofacial venous malformation. The patient underwent fluoroscopy-guided intralesional foam sclerotherapy with sodium tetradecyl sulfate and air under general anaesthesia. On awakening, after 48 h of endotracheal intubation, she displayed dysarthria and dysmetria. Her brain CT scan showed no haemorrhagic lesions. A chest CT scan ruled out a potential pulmonary embolism. Suspicion for a paradoxical embolism was high and echocardiography confirmed a patent foramen ovale, which acted as a passageway for the embolus. Transcranial ultrasound showed mild right-to-left heart shunting. The dysarthria and dysmetria disappeared gradually over 48 h, thus confirming a reversible ischaemic neurological deficit. A brain MRI performed 1 week later showed no ischaemic or haemorrhagic lesions. The patient recovered completely. She was advised cardiosurgical follow-up and discharged.

• Authors: Fabiana Allevi, Dimitri Rabbiosi, Marco Mandalà, Giacomo Colletti
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2014 (Nov 24 2014) ISSN: 1757-790X [Electronic] England
• PMID: 25422340 (Publication Type: Case Reports, Journal Article)
• Copyright: 2014 BMJ Publishing Group Ltd.

Chemical References

• Sclerosing Solutions
• Sodium Tetradecyl Sulfate

Topics

• Embolism, Paradoxical (diagnosis, etiology)
• Female
• Foramen Ovale, Patent (complications, diagnostic imaging)
• Humans
• Middle Aged
• Neck (blood supply)
• Sclerosing Solutions (therapeutic use)
• Sclerotherapy (adverse effects)
• Sodium Tetradecyl Sulfate (therapeutic use)
• Ultrasonography
• Vascular Malformations (complications, therapy)
• Veins (abnormalities)