{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T06:23:48Z","timestamp":1787207028143,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Lasers Surg Med"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the first reported case of embolic stroke with hemorrhagic conversion following a dermatologic energy\u2010based device procedure, highlighting its mechanism and clinical implications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A detailed case review was conducted, including clinical presentation, imaging, and subsequent diagnostic workup. The patient provided consent for publication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A 62\u2010year\u2010old woman with a history of Chiari malformation, hypertension, and hyperlipidemia underwent full\u2010field ablative Erbium:YAG laser resurfacing for facial photodamage. During the procedure, she experienced significant pain and performed a Valsalva maneuver. Post\u2010procedure, she developed persistent blurry vision and occipital pain. Seven days later, she presented to the emergency department with left homonymous hemianopsia. Neuroimaging demonstrated a right posterior cerebral artery embolic infarct with hemorrhagic conversion. Cardiac evaluation identified a patent foramen ovale (PFO) with right\u2010to\u2010left shunt provoked by Valsalva, consistent with paradoxical embolism. She was managed conservatively with aspirin and high\u2010intensity statin therapy. Six months later, she underwent percutaneous PFO closure. At follow\u2010up, her hemianopsia persisted, while occipital pain and swelling had fully resolved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Post\u2010procedural stroke is a rare, life\u2010threatening complication that may occur after medical interventions, including energy\u2010based dermatologic procedures. In this case, paradoxical embolism through an undiagnosed PFO, facilitated by intraprocedural Valsalva, was the likely mechanism. Dermatologists should remain vigilant for this possibility and optimize pain control to reduce Valsalva and associated thromboembolic risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lsm.70194","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T05:28:14Z","timestamp":1787203694000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stroke Following Facial Laser Resurfacing Procedure\u2014A Case Report"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1975-7084","authenticated-orcid":false,"given":"Tal","family":"Levy","sequence":"first","affiliation":[{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6513-7129","authenticated-orcid":false,"given":"Joel L.","family":"Cohen","sequence":"additional","affiliation":[{"name":"AboutSkin Dermatology and AboutSkin Research Greenwood Village Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/lsm.20286","article-title":"Complications of Laser Dermatologic Surgery","volume":"38","author":"Willey A.","year":"2006","journal-title":"Lasers in Surgery and Medicine"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1111\/jocd.16182","article-title":"Spontaneous Resolution of Eruptive Papules Following Ablative Laser Resurfacing\u2014Case Report and Review of Laser\u2010Associated Eruptive Keratoacanthomas","volume":"23","author":"Nanda R.","year":"2024","journal-title":"Journal of Cosmetic Dermatology"},{"issue":"4","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"e544","DOI":"10.4317\/jced.52520","article-title":"Chronic Neuropathic Facial Pain After Intense Pulsed Light Hair Removal. Clinical Features and Pharmacological Management","volume":"7","author":"Gay\u2010Escoda C.","year":"2015","journal-title":"Journal of Clinical and Experimental Dentistry"},{"issue":"2","key":"e_1_2_11_5_1","first-page":"273","article-title":"PFO, Push\u2010Ups and Heavy Lifting; Valsalva Provocation before Cryptogenic Stroke","volume":"13","author":"Wade E.","year":"2021","journal-title":"Interventional Cardiology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","DOI":"10.1093\/bja\/el_4182","article-title":"Embolic Stroke and Per\u2010Operative Valsalva Maneuver","volume":"103","author":"Wenzinger D. A.","year":"2009","journal-title":"British Journal of Anaesthesia"},{"issue":"4","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1183\/09031936.01.00200701","article-title":"Patent Foramen Ovale Causing Position\u2010Dependent Shunting in a Patient, When Laying down Her Corset","volume":"18","author":"Faller M.","year":"2001","journal-title":"European Respiratory Journal"},{"issue":"1","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jvs.2009.07.092","article-title":"Stroke Following Endovenous Laser Treatment of Varicose Veins","volume":"51","author":"Caggiati A.","year":"2010","journal-title":"Journal of Vascular Surgery"},{"issue":"3","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jccase.2022.11.001","article-title":"Patent Foramen Ovale\u2010Related Paradoxical Embolism After Noncardiac Surgery","volume":"27","author":"Mojaddedi S.","year":"2022","journal-title":"Journal of Cardiology Cases"},{"issue":"1","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1159\/000514706","article-title":"When in Trouble Think of the Bubble: Paradoxical Cerebral Arterial Gas Embolism After Endoscopic Retrograde Cholangiopancreatography","volume":"15","author":"Ekmektzoglou K.","year":"2021","journal-title":"Case Reports in Gastroenterology"},{"issue":"16","key":"e_1_2_11_11_1","first-page":"357","article-title":"Stroke Due to Air Embolism Related to Laser Ablation of Accessory Vein","volume":"86","author":"Kale P.","year":"2016","journal-title":"Neurology"},{"issue":"2","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1067\/mjd.2003.47","article-title":"Thrombotic Complications Related to Discontinuation of Warfarin and Aspirin Therapy Perioperatively for Cutaneous Operation","volume":"48","author":"Kovich O.","year":"2003","journal-title":"Journal of the American Academy of Dermatology"},{"issue":"6","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"NP602","DOI":"10.1093\/asj\/sjaa381","article-title":"Asymptomatic Stroke After Hyaluronic Acid Filler Injection: Case Report and Literature Review","volume":"41","author":"Moore R. M.","year":"2021","journal-title":"Aesthetic Surgery Journal"},{"issue":"1","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.31728\/jnn.2023.00139","article-title":"Hemorrhagic Stroke and Blindness After Hyaluronic Acid\/Polylactic Acid Filler Injection","volume":"15","author":"Yoon Y. J.","year":"2023","journal-title":"Journal of Neurosonology and Neuroimaging"},{"issue":"2","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1051\/mbcb\/2023021","article-title":"A Stroke Mimicker Following Inferior Alveolar Nerve Block: A Case Report","volume":"29","author":"Hassan M. K.","year":"2023","journal-title":"Journal of Oral Medicine and Oral Surgery"},{"issue":"10","key":"e_1_2_11_16_1","first-page":"1216","article-title":"Acute Ischemic Stroke Following Lidocaine Injection","volume":"8","author":"Farara N. E.","year":"2020","journal-title":"Annals of Pediatrics and Child Health"}],"container-title":["Lasers in Surgery and Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lsm.70194","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lsm.70194","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lsm.70194","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T05:28:17Z","timestamp":1787203697000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lsm.70194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":15,"alternative-id":["10.1002\/lsm.70194"],"URL":"https:\/\/doi.org\/10.1002\/lsm.70194","archive":["Portico"],"relation":{},"ISSN":["0196-8092","1096-9101"],"issn-type":[{"value":"0196-8092","type":"print"},{"value":"1096-9101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"assertion":[{"value":"2025-10-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"lsm.70194"}}