Cerebrovascular ischemia following ultrasound-guided foam sclerotherapy

Abstract Cerebral ischemia is a very rare and harmful complication of ultrasound-guided foam sclerotherapy for treatment of varicose veins. This case describes a documented cerebrovascular ischemia in Broca’s area following ultrasound-guided foam sclerotherapy. Less than one hour after intravenous injection of 10 ml of sclerosing foam, an otherwise healthy woman experienced aphasia without any other signs of neurological changes. When she arrived home, a complete inability to talk was observed. The event was misdiagnosed by another doctor as an allergic reaction. Next morning she came to the office to report the allergic reaction, where an appropriate diagnosis was made. She recovered just two days after the injection, but signs of recent cerebral ischemia were seen in Broca’s area on magnetic resonance and transesophageal bubble study echocardiogram revealed a patent foramen ovale. Although rare, we must make great effort to prevent these events instead of treating them.

摘要：脑缺血是超声引导下泡沫硬化疗法治疗静脉曲张过程中一种极为罕见且危害性显著的并发症。本病例报告了1例接受超声引导下泡沫硬化疗法后，布罗卡区（Broca’s area）出现经证实的脑血管缺血事件。患者为既往健康女性，在静脉注射10ml硬化剂泡沫后不足1小时即出现失语症，未伴随其他神经系统异常体征。返家后，其完全无法言语的症状被发现。该事件曾被另一名医师误诊为过敏反应。次日上午，患者前往诊室告知此次过敏反应情况，接诊医生遂作出正确诊断。患者在注射后仅2天便完全康复，但磁共振成像（magnetic resonance）检查显示其布罗卡区存在近期脑缺血征象，经食管气泡超声心动图检查发现存在卵圆孔未闭。尽管此类事件发生率极低，我们仍需全力做好预防工作，而非仅依赖事后治疗。