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Abstract Details

Misdiagnosis of intraventricular hemorrhage in a patient with intraocular silicone: a radiographic caveat
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
210
To describe a rare presentation of Silicone migration into the ventricles misdiagnosed for Intraventricular hemorrhage.
Intracranial migration of silicone oil is rare in individuals who undergo silicone implantation after intraocular surgeries for conditions like retinal detachment.
Case Report. A 44-year-old right-handed white male with history of hypertension, hyperlipidemia, Diabetes complicated by retinopathy (Complex retinal detachment surgery in 2012 with Silicone Oil) presented with acute onset left sided numbness and tingling with NIHSS of 1. Physical examination showed no vision in the right eye and decreased visual acuity in the left eye (20/400), left hemisensory loss to pinprick/light touch. Initial Computed tomography head without contrast was reported as intraventricular hemorrhage in the frontal horns or possible focal ependymal/subependymal hemorrhage. Magnetic resonance imaging Brain without contrast was obtained that showed a focal area of diffusion restriction over posterior aspect of the right pons consistent with acute ischemic stroke. The intraventricular lesions showed T2 Fluid-attenuated inversion recovery and Diffusion weighted imaging hypointense signal matching that of cerebrospinal fluid but these lesions did not restrict on DWI. The right lesion measured 0.8 centimeter and the left lesion measured 1.3 centimeter.
On further literature review and consultation with neuroradiology, in the context of reported history of silicone implantation we concluded that the bifrontal opacities are due to migration of silicone oil from the left eye from the prior retinal detachment surgery done in 2012.
Intraocular silicone oil tamponade is widely used for retinal detachment surgeries and considered safe in clinical practice. One hypothesis is silicone oil most likely migrates into the ventricles via the optic nerve and subarachnoid space with macrophage mediated migration1. Thorough history and examination along with close review of imaging studies is required to identify intraocular migration of silicone as this can reduce misdiagnosis and unnecessary work up.
Authors/Disclosures
Naga Krishnakanth Madireddy, MD (Baptist Health Louisville)
PRESENTER 		Dr. Madireddy has nothing to disclose.
Ashok Reddy Polu, MD (Fort Sanders Regional Medical Center) Dr. Polu has nothing to disclose.
Vishwanath Sagi, MD, FÂ鶹´«Ã½Ó³»­ (University of Louisville, Department of Neurology) Dr. Sagi has nothing to disclose.