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- patent foramen ovale
- paradoxical brain embolism
- cerebrovascular disease
- clinical neurology
A 33-year-old man presented with symptomatic varicose great saphenous veins (GSV). His vascular risk factors were limited to active smoking and obesity, and he had no past history of venous pathology. In April 2008, he underwent foam sclerotherapy carried out according to European consensus guidelines.1 A preprocedure duplex colour sonography demonstrated right GSV incompetence. The GSV was cannulated first in order to minimise the delay between foam production and injection. Foam was produced using the Tesssari method, with a 4:1 air:liquid ratio. The patient received a single injection of 4 cm3 of 0.5 % polidocanol foam. The foam was injected with the patient's leg slightly elevated while compressing the sapheno-femoral junction. Compression stockings were applied with the leg elevated. The patient was discharged without any complication.
Four hours after injection, the patient suddenly felt nauseous and developed intense vertigo. A diagnosis of transient side effect due to foam sclerotherapy was established, and a symptomatic treatment with anti-inflammatory drugs was started. Five days after symptom onset, the patient was referred to our acute stroke unit because he was still nauseous and unable to stand. The neurological examination showed a left lower facial paresis, mildly …
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