Taiwan J Fam Med Vol. 24 No.1 (blunttip microcannula) 1.0 ml Juvederm XC, ALLERGAN, (radix) (hyaluronidase) 1A 36.1 C57 / 16 / 144/85mmHg (13

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1 [] 35 一病例報告 : 玻尿酸注射鼻整型術後單眼失明及兩側大腦梗塞張馨丰 1,2 陳建志 3,4 蔡立泰 5 陳登郎 mg aspirin ; 24: DOI: / hyaluronic acid, injection augmentation rhinoplasty, retinal ischemia, cerebral infarction, micro-cosmetic surgery (hyaluronic acid) (N-acetyl d-glucosamine) (d-glucuronic acid) [1] [2] [3] [4] kg/m

Taiwan J Fam Med 36 2014 Vol. 24 No.1 (blunttip microcannula) 1.

1 C57 / 16 / 144/85mmHg (13 mmhg) (cherry-red spot) 2 (recombinant tissue plasminogen activator, r-tpa) 9

2 Taiwan J Fam Med Vol. 24 No.1 (blunttip microcannula) 1.0 ml Juvederm XC, ALLERGAN, (radix) (hyaluronidase) 1A 36.1 C57 / 16 / 144/85mmHg (13 mmhg) (cherry-red spot) 2 (recombinant tissue plasminogen activator, r-tpa) 9 (dysmetria) 36.0 C97 / 20 / 136/84 mmhg 4+ Medical Research Council [MRC] 5 Babinski (finger-nose-finger test) (heel-shin-knee test) 3A 3B (National Institutes of Health Stroke Scale, NIHSS) 1 NIHSS mg aspirin 1A 1B 5 2 (OD) (OS)

103 24 1 丰 37 3A (DWI) (TR/TE:6,500/73.3) (ADC)(TR/TE:6,500/73.3) 3B(TR/ TE: 35/2.

3 丰 37 3A (DWI) (TR/TE:6,500/73.3) (ADC)(TR/TE:6,500/73.3) 3B(TR/ TE: 35/2.7) (holter) B12 IgG IgM IgG C3 C4 2-IgG IgM IIIC S (rapid plasma reagin test) mm (patent foramen ovale) 5 1B 2 3 [5] 3 [1] 1 5 [6] 2006 [7]

4 Taiwan J Fam Med Vol. 24 No.1 (dorsal nasal artery) (ophthalmic artery) (central retinal artery) [8,9] [10] 3B (anterior ethmoid artery) (external nasal branch) (Tydall effect) 2% [3] [1] [3,4] acetazolamide [7] timolol maleate acetazolamide aspirin [8] methylprednisolone aspirin [11] [9] [12] 1) 30 2) 3) 4) 5) [13-15]

5 丰 Xue K, Chiang CA, Liu K, Gu B, Li Q: Multiplane hyaluronic acid rhinoplasty. Plast Reconstr Surg 2012; 129: 371e-2e. 3. Park TH, Seo SW, Kim JK, Chang CH: Clinical experience with hyaluronic acid-filler complications. J Plast Reconstr Aesthet Surg 2011; 64: Chatzikonstantinou A, Wolf ME, Hennerici MG: Ischemic stroke in young adults: classification and risk factors. J Neurol 2012; 259: Danesh-Meyer HV, Savino PJ, Sergott RC: Case reports and small case series: ocular and cerebral ischemia following facial injection of autologous fat. Arch Ophthalmol 2001; 119: Peter S, Mennel S: Retinal branch artery occlusion following injection of hyaluronic acid (Restylane). Clin Experiment Ophthalmol 2006; 34: He MS, Sheu MM, Huang ZL, Tsai CH, Tsai RK: Sudden bilateral vision loss and brain infarction following cosmetic hyaluronic acid injection. JAMA Ophthalmol 2013; 131: Kim EG, Eom TK, Kang SJ: Severe visual loss and cerebral infarction after injection of hyaluronic acid gel. J Craniofac Surg 2014; 25: http://www. appledaily.com.tw/appledaily/article/ headline/ / Kim YJ, Kim SS, Song WK, Lee SY, Yoon JS: Ocular ischemia with hypotony after injection of hyaluronic acid gel. Ophthal Plast Reconstr Surg 2011; 27: e Roberts R, Braunwald E, Muller JE, et al: Effect of hyaluronidase on mortality and morbidity in patients with early peaking of plasma creatine kinase MB and non-transmural ischaemia. Multicentre investigation for the limitation of infarct size (MILIS). Br Heart J 1988; 60: Narins RS, Jewell M, Rubin M, Cohen J, Strobos J: Clinical conference: management of rare events following dermal fillers--focal necrosis and angry red bumps. Dermatol Surg 2006; 32: Glaich AS, Cohen JL, Goldberg LH: Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers. Dermatol Surg 2006; 32: Fulton J, Caperton C, Weinkle S, Dewandre L: Filler injections with the blunt-tip microcannula. J Drugs Dermatol 2012; 11:

6 40 [Case Report] Unilateral Blindness and Bilateral Cerebral Infarctions Following Hyaluronic Acid Injection Rhinoplasty: A Case Report Hsin-Feng Chang 1,2, Jiann-Jy Chen 3,4, Li-Tai Tsai 5 and Dem-Lion Chen 6 A 25-year-old woman suddenly lost vision in her right eye during hyaluronic acid injection augmentation rhinoplasty. The fundus examination showed a cherry-red spot and severe edematous opacity in the right retina. Nine hours later, her left upper limb became weak. Brain magnetic resonance imaging demonstrated multiple acute infarctions in the cerebral hemispheres despite an unremarkable magnetic resonance angiogram. She took oral aspirin (100 mg daily) and received intravenous fluid supportive treatment during the ensuing hospitalization. Five days later, strength in the left upper limb power returned, but vision was not restored in the right eye. Three months later, the visual ability in the right eye had not improved. Hyaluronic acid injection has been widely utilized during micro-cosmetic surgery, but there are possible complications. Performing injection augmentation procedures should be careful when applied over the nose or glabella to prevent filler regurgitation into the central retinal artery or intracranial arteries. (Taiwan J Fam Med 2014; 24: 35-40) DOI: / Faculty of Chinese Medicine, Chinese Medical College, China Medical University, Taichung; Departments of Medical Education 2 and Neurology 4, China Medical University Hospital, Taichung; 3 Department of Neurology, Neuro-Medical Scientific Center, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung; 5 Lion Otolaryngologic Clinic, Taichung; 6 G-Home Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan. Received: August 1, 2014; Revised: October 28, 2014; Accepted: November 7, 2014.

[3] 63.6% 60.61% 33.33% (instability) (25.6%) (23.3%) (20.9%) (floating head sensation) (16.3%) (14.0%) (9.3%) (7.0%) (4.7%) [5] 37

[3] 63.6% 60.61% 33.33% (instability) (25.6%) (23.3%) (20.9%) (floating head sensation) (16.3%) (14.0%) (9.3%) (7.0%) (4.7%) [5] 37 148 [] 1 2 3,4 37 18-25 29 1 3032 10 18 4 5 B diphenhydramine promethazine metoclopramide C prochlorperazinediphenidol betahistine 2014; 24: 148-152 DOI: 10.3966/168232812014092403005 (vestibular migraine)