title: 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.affiliation: Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Allevi
authors.affiliation: Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Rabbiosi
authors.affiliation: Department of Otolaryngology, Borgo Roma Hospital, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mandalà
authors.affiliation: Department of Maxillofacial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Colletti
mesh_terms: D019320:Embolism, Paradoxical / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D009333:Neck / Q000098:blood supply*; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000009:adverse effects*; D012981:Sodium Tetradecyl Sulfate / Q000627:therapeutic use; D014463:Ultrasonography; D054079:Vascular Malformations / Q000150:complications / Q000628:therapy*; D014680:Veins / Q000002:abnormalities
chemical_list: D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate