Ischemic Stroke Following Sclerotherapy of Varicose Veins

Abstract

Sclerotherapy consists of an injection of a sclerosing foam or liquid to occlude the varicose vein. This therapeutic method is recognized for its immediate effectiveness and its low complication rate. Certain neurological complications have been reported, notably ischemic stroke (CVA), which remains a very rare complication. We report the case of Mrs. FK aged 35, without any particular personal history, who presented to vascular surgery for sclerotherapy of her varicose veins. During the procedure, the patient presented a sudden onset of impaired consciousness associated with left hemiplegia with aphasia. She was immediately transferred to medical intensive care. Brain computed tomography (CT) confirmed the diagnosis of stroke. As part of the etiological assessment, we performed a transesophageal echocardiography (TEE) on the 7th day of his hospitalization, which was in favor of a patent foramen ovale (PFO). In the literature, this complication has been reported by certain authors but it remains rare. CiVA is secondary to the presence of a PFO. It may be a gas embolism (related to the product used) in which case the stroke is early, or a cruoric embolism, in which case it occurs late. Is echocardiography systematic before sclerotherapy? Through this case and referring to the literature, we will review this entity of stroke of rare etiology.