Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3649_Библиотеки_им_академика_М_И_Перельмана

Triggering of migraine headaches, in patients who have an underlying history of recurrent migraines, has occurred after sclerotherapy. foamed sclerotherapy but most likely is more common with foamed sclerosing solutions. may occur in patients with a migraine diathesis. In such a case, the patient’s history is helpful, and the outcome is usually benign. A complete ophthalmologic examination is recom­mended in these patients to rule out other, more serious and treatable causative factors. Künzlberger et al describe a 23-year­old female who abruptly developed homonymous hemiano­pia and paresthesia in the hands and feet followed by a headache shortly after sclerotherapy with POL 1% liquid. This patient subsequently underwent an ophthalmologic as well as a neurologic examination, both of which were other­wise normal. A PFO was ruled out, and the patient’s constel­lation of symptoms completely resolved within 2 hours after its acute onset. In this case, an acute thrombosis of the cerebral artery, showing spontaneous and rapid resolution in an oth­erwise healthy, young patient seemed highly unlikely. The lack of an underlying PFO disfavored a paradoxical embolism caused by the intravenous injection of POL. Thus, the authors concluded that this patient’s homonymous hemianopia was caused by a vascular spasm in the contralateral cerebral hemi­sphere. This case demonstrates a phenomenon described as ‘migraine ophthalmique,’ which is characterized by homony­mous hemianopia without macular involvement, often accompanied by migraine, dizziness, and nausea. Whether or not certain patients have cortical regions more susceptible to systemically administered triggers (e.g. sclerotherapy at a distant site) is unclear. However, this case does demonstrate that this rare complication of sclerotherapy can occur inde­pendent of an air embolism, as liquid as opposed to foam POL was used as the sclerosant.