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Case Report: Multiple Cerebral Infarctions with Neurological Symptoms and Ophthalmic Artery Occlusion after Filler Injection

 

A 50-year-old female patient with no underlying disease visited the hospital because she complain of decreased visual acuity in the left eye immediately after the injection of hyaluronic acid filler (Restylane, Q-Med AB, Uppsala, Sweden) into the glabellar region four hours ago.

 

At that time of the visit, the best corrected visual acuity was 1.0 in the right eye and 'hand motion (HM)' (the visual acuity between finger counting (FC) and light perception (LP)) in the left eye. The intraocular pressure was 8mmHg in the right eye and 14mmHg in the left eye. In addition, the slit lamp examination revealed mild corneal oedema and folds in Descemet's membrane.

 

The direct light reflex was invisible and only the indirect light reflex was visible in the pupil of the left eye, which was led to the detection of a relative afferent pupillary defect. The movement of the left eye was so completely restricted in all directions that the patient could not move her left eye at all.

 

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Ptosis with redness and oedema was also observed in the upper eyelid of the left eye. Skin lesions with a yellow bruise and a purple spot occurred even in the nose ridge.

 

In the fundus examination conducted following the onset of mydriasis, pale retina, retinal oedema, and a cherry-red spot were observed. The fluorescein angiography (FAG) revealed a phenomenon corresponding to the central retinal artery occlusion which resulted in greatly delayed angiography. 

 

Following the detection of ophthalmic artery occlusion in the left eye, the patient underwent an anterior chamber paracentesis using a 30G needle in combination with oxygenation.

 

General symptoms included dizziness, altered state of consciousness, dysarthria, and 3-step and 4-step muscle weakness in the right upper limb and right lower limb, respectively.

 

The subsequent magnetic resonance imaging (MRI) of the brain revealed multiple local high signal intensity lesions at the frontal, temporal, parietal, and occipital lobes, which indicated that the extensive cerebral infarctions were accompanied. For the treatment of cerebral Infarction, the patient was injected with a large amount of fluid in combination with oral aspirin. 

 

- To be continued