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Acute multifocal cerebral embolism and unilateral branch retinal
artery embolism during the neck liposuction surgery:a case report
Abstract
Liposuction is a frequently performed cosmetic operation in China. The public
perception of liposuction as a minor surgery ignores the potential of the complications.
Embolism is one of the complications of the liposuction surgery. The aim of
presenting this rare case is to emphasize the possibility of embolism during the
operation , increasing awareness in the cosmetic field.
Introduction
Multifocal embolism during a general surgical procedure can be a devastating
complication for both surgeons and patients. It is difficult for a relatively healthy
person to accept the truth that he has got cerebral embolism or the more serious
complication of fat embolism syndrom (FES) during a simple liposuction procedure.It
is reported that the mortality rate for liposuction may be as high as one in 1000
cases[1]. In our case the embolism complication is not as sevious as FES, but it is still
very rare during liposuction. Our case is reported to remind doctors to pay more
attention to possible complications especially the eye symptoms during liposuction .
Case Report
A 60-year-old married male was admitted to our hospital and complained of inability
of the right arm and upper right vision field defect in the left eye during the neck
liposuction surgery under tumescent anesthesia . Then the liposuction was stopped
immediately and he was sent to emmergency room of our hospital . He was healty
except for obesity . Physical examination showed his blood pressure was 140/85
mmHg , heart rate was 72 beats per minute , the right side body powerless and eye
symptom was ignored . Magnatic resonance imaging (MRI) scan of the brain revealed
the acute multifocal cerebral embolism (Fig1) . The patient was asked for
hospitalization in the neurology department . He received intravenous medicine for
improvement of circulation and protection of nerve
(should mention the name of the
medicine). Four days later the body symptom alleviated but the eye symptom showed
no change . So he was arranged an consultation to an oculist . The ophthalmic
examination showed the vision was 1.0 and eye pressure was 16 mmHg in the left
eye . The visual field test revealed it was normal in the right eye while it was a defect
in the left eye (need to explain type of the defect & whether it relates to his clinical
signs or not) (Fig 2) . Funduscopy (should come before the visual field) revealed that
a branch retinal artery occlusion and retina around the artery was greywhite edema .
And we could find the white embolus in the retinal artery (Fig 3) . So the left eye was
a typical branch retinal artery occlusion . As the occlusion has been for four days ,
there may be was no special treatment for the eye and the vision field loss would be
permanent .
Fig 1：Magnatic resonance imaging (MRI) of brain showed scattered acute multifocal
cerebral embolism (black arrows) involving the corona radiata , frontal lobe and
parietal lobe .
Fig 2：Visual field revealed local vision field defects in the left eye .
Fig 3 : Fundus color photo revealed greywhite edema around the inferotemporal
branch retinal artery . There was the white embolus (the black arrow) in the artery .
Discussion
Liposuction surgery is an operation that can help sculpt the body by removing
unwanted fat from specific areas , including the abdomen , hips , buttocks , and
thighs . Liposuction is considered a safe procedure , but serious local and systemic
complications have been reported , such as pulmonary fat embolism , infection ,
pituitary apoplexy , deep venous thrombosis , bilateral or unilateral blindness and
death[2] . Lehnhardt M et al[3] recently reviewed retrospectively 72 cases in Germany
between 1998 to 2002 which were related to major and lethal complication of
liposuction concluded that major risk factors for the development of severe
complications are insufficient standards of hygiene , the infiltration of multiple liters
of wetting solution , permissive postoperative discharge , and selection of unfit
patients . The lack of surgical experience was a notorious contributing factor ,
particularly regarding the timely identification of developing complications . Visual
loss after liposuction is a rare complication ,with only 4 prior reports[4-7]. These 4
reports are all about vision loss resulting from ischemic optic neuropathy . Our report
is about local visual field defect because of branch retinal artery occlusion . This is
different from cases reported before . Moreover multifocal cerebral embolism and
unilateral branch retinal artery embolism happened at the same time during
liposuction which is really rare and there is no such report before . Our case is
reported to remind doctors to pay more attention to possible complications especially
the eye symptoms during liposuction . A study about retinal tolerance time to acute
ischemia revealed that there was no apparent morphometric evidence of damage with
retinal artery occlusion of less than 97 minutes, but while occlusion for 240 minutes
or more produced total optic nerve atrophy and nerve fiber damage and the damage
may be irreversible[8-9] . In our case , as the branch retinal artery occlusion was four
days function of the retina whose blood supply was from the blocked artery may be
irreversible and the visual field defect in the left eye may be permanent . So it is very
important to pay more attention to the eye symptom during liposuction .
There are some complications during liposuction . Doctors should know about the
related causes of the complications and try to avoid them . Patients also should know
about some complications related to liposuction .
Acknowledgment.
The authors would like to thank technician Shengxian Shi from the Department of
radiology .
Reference
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Lehnhardt M1, Homann HH, Daigeler A, Hauser J, Palka P, Steinau HU. Major
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