Cerebral gas embolism and multifocal ischemic stroke during oxygen-ozone therapy: a case report
Khosravi S, Mirzaasgari Z. BMJ Neurology Open, 2024.
- Study type
- Case report
- People studied
- 1 person
- Population
- 58-year-old woman with no known previous medical history, receiving a lumbar intradiscal oxygen-ozone injection for disc herniation pain
- Published
- 2024, BMJ Neurology Open
- Identifiers
- PMID 39720509, DOI 10.1136/bmjno-2024-000885
What the authors reported
During a lumbar intradiscal oxygen-ozone injection the patient developed speech disturbance and limb weakness; CT showed multiple cerebral gas bubbles and MRI showed acute infarcts in both hemispheres. Contrast echocardiography suggested a small patent foramen ovale. At 12 months she had no symptoms (Modified Rankin Scale 0).
What limits this result
Single case report: it shows the event can occur during this procedure, not how often it occurs or who is at risk. No ozone concentration or injected gas volume is reported, and the authors note that how the gas reaches the arterial circulation is not fully understood.
Harms reported after ozone therapy, and studies of how ozone exposure affects health. One study rarely settles a medical question; our guides weigh each paper against the rest of the evidence.
How the study was done
- Design
- Case report
Cerebral gas embolism and multifocal ischemic stroke during oxygen-ozone therapy: a case report
- Setting
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (author affiliation)
- Read from
- Read from the full text of the paper. Read on September 29, 2026.
Source: Abstract on PubMed
Study arms
| Group | Participants | What they received |
|---|---|---|
| Single patient | Not reported | Lumbar intradiscal oxygen-ozone injection at a local pain clinic; symptoms began during the injection |
Source: Full text on PubMed Central
What it measured
- Neurological examination on admission
- Flattened left nasolabial fold; weakness of the left upper limb and right lower limb, MRC grade 4
- Initial brain CT
- Multiple gas bubbles, suggesting cerebral gas embolism
- Diffusion-weighted MRI
- Multiple restriction areas in both cerebral hemispheres, correlating with areas of acute infarction
- Transthoracic echocardiogram with contrast
- Bubbles passing through the intra-atrial septum, suggestive of a small-sized patent foramen ovale
- Electrocardiogram
- Unremarkable for any cardiac dysrhythmia
- Carotid ultrasound
- Normal carotid arteries with normal waveforms and anterograde flow
- Course in hospital (after antiplatelet therapy was started)
- Symptoms improved; speech disturbance resolved and muscle power improved in a few days
- Examination 12 months later
- No symptoms; Modified Rankin Scale of 0
During a subsequent examination conducted 12 months later, she exhibited no symptoms with a Modified Rankin Scale of 0.
Source: Full text on PubMed Central
Safety as reported
Gas embolism and stroke, which the authors describe as complications of intradiscal and intramuscular injections during oxygen-ozone therapy
Source: Full text on PubMed Central
Follow-up
12 months
Source: Full text on PubMed Central
Funding and conflicts
No specific grant declared from any funding agency in the public, commercial or not-for-profit sectors
Source: Full text on PubMed Central
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