Ozone‐induced encephalopathy: A novel iatrogenic entity. (19th March 2021)

• Record Type: Journal Article
• Authors: Haggiag, Shalom; Prosperini, Luca; Stasolla, Alessandro; Gerace, Carmela; Tortorella, Carla; Gasperini, Claudio
• Is Part Of: European journal of neurology. Volume 28:Number 8(2021)
• Page Start: 2471
• Page End: 2478
• Publication Date: 2021-03-19
• Subjects: brain diseases -- headache -- ozone -- stroke; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.14793
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: Background and purpose: Ozone‐based treatments can be associated with central nervous system toxicity, which we have termed ozone‐induced encephalopathy (OIE). A detailed description of its phenotype is lacking. Methods: Three cases with findings suggestive of OIE are presented, and the literature is reviewed. Results: Case 1 is a healthy 59‐year‐old man presenting with loss of consciousness, cortical blindness, restlessness, and anterograde amnesia immediately following a cervical ozone‐therapy (OT) session for chronic neck pain. Brain magnetic resonance imaging (MRI) on admission was normal. A follow‐up scan demonstrated a subtle increased T2 fluid‐attenuated inversion recovery signal within the left cerebellum; an echocardiography showed a patent foramen ovale (PFO). Case 2 is a 56‐year‐old woman with history of migraine, PFO, and lumbar pain who presented with headache, bilateral visual impairment, motor dysphasia, and agitation. All her symptoms began immediately after lumbar OT. Her brain MRI was negative. Case 3 is a healthy 27‐year‐old man who complained of vertigo and mild blurred vision 5 min following a cervical ozone injection. His neurological examination and brain MRI were normal. All three patients had full recovery within 48 h. We found eight additional cases of OIE in the literature. Conclusions: OIE should be considered in patients presenting with neurological symptoms in close relation to OT. OIE is likely a novel iatrogenic entity with a complex pathogenesis; it is probably underreported because it mimics other neurological conditions. Abstract : Ozone‐based treatments are associated with central nervous system toxicity, what we have called ozone induced encephalopathy (OIE). Three new patients with OIE are presented, and the literature is reviewed. This is likely a novel iatrogenic entity, and clinicians should be aware of this complication and its management.