Abstract Details

Title Basilar Artery Air Embolus Complicating Vein Foam Sclerotherapy

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P05 - (-)

Poster/Presentation
Number 211

Objective

Background BACKGROUND: Cerebral arterial gas embolism (CAGE), is a serious complication of interventional procedures. An increasing number of cases of CAGE complicating venous sclerotherapy1 have been reported. Prompt recognition and treatment with hyperbaric oxygen therapy (HBOT) can prevent or minimize devastating sequelae.

Design/Methods DESIGN/METHODS: Case Report.

Results RESULTS: A 59 year old man undergoing bilateral lower extremity (LE) foam sclerotherapy developed headache, nausea, dizziness, vertigo, right facial palsy, and right face, arm, and leg paresthesias (NIHSS=1). Initial noncontrast head CT demonstrated air emboli in the bilateral middle cerebral and vertebral arteries. The patient was placed on supplemental oxygen and transferred to a tertiary care facility. CT angiography demonstrated air in the basilar artery. MRI demonstrated an acute ischemic stroke in the right cerebellar hemisphere. The patient was treated with HBOT at United States Navy Table 6. The patient's symptoms improved, and follow-up on hospital day two was remarkable for mild ataxia and bilateral end-gaze nystagmus (NIHSS=0).

Conclusions CONCLUSIONS: CAGE is an uncommon serious complication of invasive medical procedures. HBOT is considered the gold standard treatment for CAGE, and initiation within 6 hours has been associated with favorable clinical outcomes2. We describe a case of CAGE complicating foam sclerotherapy of LE venous disease, responsive to HBOT. This case demonstrates the presentation of a CAGE, highlights an unusual cause, and emphasizes the need for prompt treatment with HBOT. References 1. Sarvananthan. Neurological complications of sclerotherapy for varicose veins. Journal of vascular surgery. 2012;55(1):243-251. doi: 10.1016/j.jvs.2011.05.093. 2. Tekle WG, Adkinson CD, Chaudhry SA, Jadhav V, Hassan AE, Rodriguez GJ, Qureshi AI. Factors Associated with Favorable Response to Hyperbaric Oxygen Therapy among Patients Presenting with Iatrogenic Cerebral Arterial Gas Embolism. Neurocrit Care. 2012 Mar 7.

Authors/Disclosures
Tara M. Dutta, MD (Wellspan) PRESENTER	No disclosure on file
	No disclosure on file
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Heinz Reichmann, MD, FAAN (Dept. Neurology)	Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bial. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zambon. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyowa. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bial. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zambon. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyowa. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bial. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Zambon. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme. Dr. Reichmann has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wissenschaftsverlag.

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