Stroke following variceal sclerotherapy.
OBJECTIVE
Paradoxical embolism via a patent foramen ovale (PFO) has been identified as a potential risk factor for ischaemic stroke. Such occurrences are associated with risk factors for deep vein thrombosis (DVT), e. g. pregnancy, immobilisation, and surgery of the lower limbs.


METHODS
A 54-year-old otherwise healthy female presented with acute onset motoric aphasia and brachiofacial right hemiparesis. The cranial computed tomography showed a left striatal ischaemic infarction. The patient's history revealed a variceal sclerotherapy with polydocanol 0,5% three days prior to the onset of symptoms. Echovist TCM doppler revealed a right-to-left shunt. A patent foramen ovale (PFO) was detected by transesophageal echocardiography. There was no evidence of DVT in bilateral lower-extremity venous duplex ultrasound scanning. Other potential risk factors of stroke including thrombophilia could not be identified. The patient was treated with a high dose regimen of heparin and a further anticoagulation treatment was recommended.


CONCLUSIONS
This case suggests a probable causal relationship between variceal sclerotherapy and paradoxical embolism resulting in a stroke. Variceal sclerotherapy might be a potential, but rare risk of embolism.
Hanisch
Frank
F
Neurologische Klinik, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany. frank.hanisch@medizin.uni-halle.de
Müller
T
T
Krivokuca
M
M
Winterholler
M
M
D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D015911:Sclerotherapy / Q000009:adverse effects*; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014648:Varicose Veins / Q000150:complications / Q000628:therapy*