Acute Ischemic Stroke in a Young Woman With No Known Risk Factors.

INTRODUCTION: We aim to highlight a potentially morbid consequence of foam-sclerotherapy for the treatment of varicose veins. CASE REPORT: We report a case of a 41-year-old woman with no significant medical history who presented to the emergency department with sudden onset of focal neurologic deficits. She had undergone varicose vein treatment with foam sclerotherapy 2 days prior. Magnetic resonance imaging of the brain showed acute cerebellar infarct. Computed tomography angiography was unremarkable. Transesophageal echocardiography showed the presence of a very small patent foramen ovale. DISCUSSION: Transient neurologic symptoms reported in patients undergoing venous foam sclerotherapy might have been transient ischemic attacks or acute ischemic strokes. The risk of these neurologic complications should be explained to all patients undergoing foam sclerotherapy so they can make an informed decision of screening echocardiography prior to the procedure. CONCLUSION: Onset of neurologic symptoms can be immediate or delayed in patients undergoing venous foam sclerotherapy. Early recognition of neurologic deficits resulting from paradoxical gas embolism and its treatment with hyperbaric oxygen can prevent permanent disability.

Osteoporosis and multiple sclerosis: risk factors, pathophysiology, and therapeutic interventions.

Multiple sclerosis (MS) is a chronic inflammatory-demyelinating disease of the nervous system. There has been mounting evidence showing that MS is associated with increased risk of osteoporosis and fractures. The development of osteoporosis in MS patients can be related to the cumulative effects of various factors. This review summarizes the common risk factors and physiologic pathways that play a role in development of osteoporosis in MS patients. Physical inactivity and reduced mechanical load on the bones (offsetting gravity) is likely the major contributing factor for osteoporosis in MS. Additional possible factors leading to reduced bone mass are low vitamin D levels, and use of medications such as glucocorticoids and anticonvulsants. The role of the inflammatory processes related to the underlying disease is considered in the context of the complex bone metabolism. The known effect of different MS disease-modifying therapies on bone health is limited. An algorithm for diagnosis and management of osteoporosis in MS is proposed.