Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 1. Coleman, W. P., Hanke, C. W., and Glogau, R. G. Does the specialty of the physician affect fatality rates in liposuction?A comparison of specialty specific data. Dermatol. Surg. 26:611, 2000. 2. Moura FC, Cunha LP, Monteiro ML. Bilateral visual loss after liposuction: case report and review of the literature. Clinics (Sao Paulo). 2006 Oct;61(5):489-91. 3. Lehnhardt M1, Homann HH, Daigeler A, Hauser J, Palka P, Steinau HU. Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plast Reconstr Surg. 2008 Jun;121(6):396e-403e. 4. Minagar A, Schatz NJ, and Glaser JS. Liposuction and ischemic optic neuropathy. Case report and review of literature. J Neurol Sci.2000;181:132-6. 5. Foroozan R, Varon J. Bilateral anterior ischemic optic neuropathy after liposuction. J Neuroophthalmol. 2004;24:211-3. 6. Sibgatullah MKM, Zerykier A, Volpe S. Ischemic optic neuropathy after liposuction: case report and review. J Neuroophthalmol. 2005;29:91-3. 7. Moura FC, Cunha LP, Monteiro ML.Bilateral visual loss after liposuction: case report and review of the literature. Clinics.2006; 61(5):489-91. 8. Hayreh SS, Zimmerman MB, Kimura A, Sanon A. Central retinal artery occlusion. Retinal survival time. Exp Eye Res. 2004; 78:723–736. 9. Hayreh SS, Jonas JB. Optic disk and retinal nerve fiber layer damage after transient central retinal artery occlusion: an experimental study in rhesus monkeys. Am J Ophthalmol. 2000; 129:786–795.