Acute Ischemic Stroke in a Young Woman With No Known Risk Factors

We aim to highlight a potentially morbid consequence of foam-sclerotherapy for the treatment of varicose veins.

We report a case of a 41-year-old woman with no significant medical history who presented to the emergency department with sudden onset of focal neurologic deficits. She had undergone varicose vein treatment with foam sclerotherapy 2 days prior. Magnetic resonance imaging of the brain showed acute cerebellar infarct. Computed tomography angiography was unremarkable. Transesophageal echocardiography showed the presence of a very small patent foramen ovale.

Transient neurologic symptoms reported in patients undergoing venous foam sclerotherapy might have been transient ischemic attacks or acute ischemic strokes. The risk of these neurologic complications should be explained to all patients undergoing foam sclerotherapy so they can make an informed decision of screening echocardiography prior to the procedure.

Onset of neurologic symptoms can be immediate or delayed in patients undergoing venous foam sclerotherapy. Early recognition of neurologic deficits resulting from paradoxical gas embolism and its treatment with hyperbaric oxygen can prevent permanent disability.