Neurological symptoms following exposure to ozone

Updated Review on Ozone Therapy in Pain Medicine

The use of medical ozone in the treatment of chronic pain is progressively expanding in Spain and today it is used both in public and private medical centers. However, there is a great lack of knowledge about this technology not only in primary care but also in medical specialties. Although its biochemical bases are well determined and there are various systematic reviews and meta-analyses in the literature that justify its use in pain medicine, some professionals still are prejudiced against it. The evidence level of using medical ozone according SIGN (Scotish Intercollegiate Guideline Network) criteria is similar or superior to most of the techniques used in a Pain Unit. In this paper, we have done a review on ozone therapy in pain medicine, compiling the evidence published about it.

Ozone-induced encephalopathy: A novel iatrogenic entity

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.

Transient cortical blindness after intradiscal oxygen-ozone therapy

A 54-year-old caucasian male developed bilateral blindness during an oxygen–ozone injection for disc herniation. The visual loss (VL) was immediately followed by severe frontal headache, vomiting, and nausea. The patient underestimated the VL showing Anton's syndrome, with a complete visual recovery after 2-month follow-up. Magnetic resonance data were consistent with recent ischemic lesions in bilateral vascular territories of posterior cerebral arteries.