Article

Anton syndrome during oxygen-ozone therapy

image of Figure

Case Report

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American Journal of Emergency Medicine

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American Journal of Emergency Medicine 33 (2015) 856.e1-856.e2

Anton syndrome during oxygen-ozone therapy

Abstract

Ozone (O3) gas is a molecule that consists of 3 oxygen atoms, found out in the mid-19th century [1]. Ozone gas preserves humans from detrimental influences of ultraviolet radiation [1]. In spite of harmful effects of O3 gas, investigators think that it has excessive curative effects [1]. Nowadays, O3 therapy is used for many fields of medicine in precise Therapeutic doses [1,2]. It is known that O3 therapy is helpful in Dental procedures, cerebrovascular diseases, tinnitus, acquired immunodeficien- cy syndrome, hypercholesterolemia, sensorial hypoacusis, senile demen- tia, Multiple sclerosis, irradiation sensitive tumors, herpes simplex and herpes zoster virus infections, muscular hypertonia, and chronic Otitis media, etc.[2]. The complications and disadvantages of O3 therapy could be observed in the future. Herein, we presented a case of ischemic stroke after an oxygen-O3 therapy, which is called also Anton syndrome.

A 36-year-old woman admitted at the emergency department with nausea and vomiting for 16 hours in addition to sudden onset of bilateral blindness and loss of strength for 6 hours. The patient had been taking inhalation oxygen-O3 therapy for 1 week for tinnitus and hearing loss based upon Meniere disease. The patient’s vital signs and laboratory examinations were in reference ranges. At admission, the patient was disoriented and unconscious. The neurologic examination revealed loss of strength at right inferior and superior extremities, dysartrhia, and bilateral cortical blindness. Electrocardiography showed normal sinusal rhythm. A computed tomographic scan showed hypodense areas in right occipital region and left thalamus region. And also, it

showed hypodense area in the right cerebellar hemisphere. There was no signal of recent Ischemic or hemorrhagic stroke. Diffusion-weighted magnetic resonance imagining showed acute diffusion restriction in cerebello-occipital and left thalamus regions (Figure). The patient was hospitalized in neurology intensive care unit for 14 days. The patient is still on Physical therapy program in our hospital for 26 days.

The use of oxygen-O3 therapy is prevalent, and manifold methods of this therapy are used in otorhinolaryngology [2]. It is known that oxygen-O3 air therapy is the most common method [2]. The other tech- niques to supply O3 therapy are rectal, vaginal, and ear insufflations; injection to veins, joints, muscles, and tumors; and bagging of the use of ozonated water and oil orally and externally [2].

Bilateral cortical blindness that called Anton syndrome is generally seen after an ischemic stroke [3]. Bilateral infarcts of posterior cerebral arteries are associated with Anton syndrome, and primary visual cortex and visual association area effect from these infarcts [3].

In 2004, Corea et al [4] reported a 66-year-old-woman who is the first case of ischemic stroke after medical oxygen-O3 therapy. In that case, hy- poperfusion of basilar artery was called Anton syndrome. Spontaneous bilateral infarct of posterior cerebral artery is commonly associated with embolism or a thrombus from basilar artery [4]. In our case, there was not any risk factor that could be associated with ischemic stroke, and our case is similar with the case that Corea et al [4] reported.

We thought that this case report indicates the importance of the Possible complications of oxygen-O3 therapy. This therapy method should be investigated in detailed to avoid serious complications.

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Figure. Diffusion-weighted magnetic resonance imagining shows diffusion restriction in cerebello-occipital and left thalamus regions.

0735-6757/(C) 2014

S. Avci et al. / American Journal of Emergency Medicine 33 (2015) 856.e1856.e2 856.e2

Sema Avci, MD? Fatih Buyukcam, MD Omer Faruk Demir, MD

Seda Ozkan, MD

Department of Emergency Medicine, Diskapi Yildirim Beyazit Training and

Research Hospital, Ankara, Turkey

?Corresponding author. Tel.: +90 312 596 2000, +90 530 843 13 63;

fax: +90 312 318 6690.

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.11.041

References

  1. Elvis AM, Ekta JS. Ozone therapy: a clinical review. J Nat Sci Biol Med 2011;2(1): 66-70. http://dx.doi.org/10.4103/0976-9668.82319.
  2. Pawlak-Osinska Katarzyna, Kazmierczak Henryk, Kazmierczak Wojciech, Szpoper Magdalena. Ozone therapy and pressure-pulse therapy in Meniere’s disease. Int Tinnitus J 2004;10(1):54-7.
  3. Kwong Yew K, Abdul Halim S, Liza-Sharmini AT, Tharakan J. Recurrent bilateral occipital infarct with cortical blindness and Anton syndrome. Case Rep Ophthalmol Med. 2014, 2014 [795837].
  4. Corea F, Amici S, Murgia N, Tambasco N. A case of vertebrobasilar stroke during oxygen-ozone therapy. J Stroke Cerebrovasc Dis 2004;13(6): 259-61.

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