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Abstract
Purpose
To report a case of visual loss, side weakness and facial palsy due to ophthalmic artery occlusion with diffuse multiple cerebral infarctions after injection of hyaluronic acid.
Case summary
A 50-year-old female visited our clinic for visual loss in the left eye after filler injection in the glabella. Her best corrected visual acuity was 1.0 in the right eye and hand motion in the left eye. The intraocular pressure was 8 mm Hg in the right eye and 14 mm Hg in the left eye. In the left eye, there was abnormal pupillary light reflex and complete extraocular muscles palsy with blepharoptosis. A pale retina with a cherry-red-spot also appeared in the left fundus. A central retinal artery occlusion was observed on fluorescein angiography and brain magnetic resonance imaging showed multiple cerebral infarctions at the frontal, temporal, parietal and occipital lobes. Four days later, the motor weakness was aggravated and dysarthria and aphasia became worse. According to symptoms, a hemorrhagic transformation in subacute infarctions developed based on brain computed tomography. After 3 months of follow up, the visual acuity in the left eye was no light perception. However, the general conditions including ophthalmoplegia and motor weakness were improved.
References
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Figure 1.
(A) Initial facial photographs show erythematous left eyelid swellings with blepharoptosis, severe conjunctival chemosis, subconjunctival hemorrhage in the left eye and (B) purpura like rash at nasal ala and forehead.
Figure 2.
(A) Fundus pho- tographs show normal in right eye, (B) but pale retina and thin vessels with cherry red spot in the left eye. (C) Fundus fluorescein angiographs show normal in the right eye, (D) non- perfusion of retina and choroid in the left eye about 2 minute after dye injection.
Figure 3.
(A, B) Brain diffuse MRI (axial view) shows multiple high signal intensity lesions on left cerebral hemisphere (frontal, temporal, occipital, parietal lobes) which were suspected recent infarctions of middle cerebral artery territory (arrows).
Figure 4.
(A, B: axial view), (C: sagittal view), (D: coronal view) 4 days after filler injection, brain CT shows multiple hyper-dense hemorrhages (arrows) at left cerebral hemisphere (fro- ntal, temporal, occi-pital, parietal lobes) which mean hemorrhagic transfor- mation in subacute infarct- ions.
Figure 5.
3 months after filler injection (A) anterior segment photograph shows posterior synechiae and oval-shape fixed pupil. (B) Fundus photograph shows fibrovasular membrane around the disc and posterior pole. (C) Fundus fluorescein an-giograph shows hyperfluorescence because of fibrovascular membrane about 1 minute after dye injection.
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