Cerebral Gas Embolism and Multifocal Ischemic Stroke During Oxygen-Ozone Therapy: A Case Report Publisher



Khosravi S^{1, 2} ; Mirzaasgari Z¹
Source: BMJ Neurology Open Published:2024

Abstract

Introduction Ischaemic stroke, primarily caused by thromboembolic events, typically arises as a consequence of underlying vascular or cardiac pathology. Non-thrombotic embolic strokes, although rare, are increasingly seen in interventional and intravascular procedures. Oxygen-ozone therapy (OOT) is one of the popular treatments for lumbar disc herniation, providing pain relief. However, it has been linked to gas embolisms, posing severe risks. This article details a case of cerebral gas embolism and multifocal acute ischaemic stroke that occurred during OOT for lumbar disc herniation pain relief. Case presentation We present a case of a 58-year-old woman with acute onset limb weakness and speech disturbance that happened during a lumbar intradiscal oxygen-ozone injection session. Brain CT and MRI scans showed multiple cerebral gas embolisms and diffusion-restricted areas in both cerebral hemispheres. Echocardiography revealed a patent foramen ovale, hinting at a conduit for paradoxical embolism. Follow-up of the patient after 1 year showed significant improvement. Conclusion OOT, as a popular treatment for chronic pain, has been associated with severe adverse events. When facing cases of acute postoperative or postinterventional encephalopathy or stroke, arterial cerebral gas embolism should be considered a possibility. The presence of intracardiac defects or intrapulmonary shunts paves the way for paradoxical emboli to happen, resulting in a higher chance of neurological complications. © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.