Relationship between augmentation index and acute ischemic stroke subtype.

The aim of the present study was to explore the relationship between augmentation index (AIx) and vascular risk factors according to stroke subtypes. Patients were eligible for this study if they experienced their first ischemic stroke within the preceding 7 days and were 45 years of age or older. AIx was measured by applanation tonometry (SphygmoCor, AtCor Medical, Sydney, Australia) and ischemic stroke was classified according to the Trial of Org 10172 in the Acute Stroke Treatment (TOAST) classification system. A total of 189 patients were enrolled. The most frequent stroke subtype was lacune (76, 40.2%), followed by stroke of undetermined etiology, negative work-up (SUDn) (59, 31.2%), large artery atherosclerosis (LAA) (31, 16.4%), and cardioembolism (23, 12.2%). While there were no significant differences among the groups for hemodynamic indices, AIx at 75 beats per minute (AIx@75) was higher in lacune subtype (29.6%) than SUDn (28.4%), LAA (26.6%), and cardioembolism (24.8%) (p=0.064). The AIx@75 was significantly related to age (r=0.189), sex (r=0.252), peripheral systolic blood pressure (SBP) (r=0.189), peripheral diastolic blood pressure (DBP) (r=0.191), and peripheral mean arterial pressure (MAP) (r=0.327). Multiple linear regression analysis revealed that age, sex, peripheral SBP, peripheral DBP and peripheral MAP were significant (p<0.002). This study showed that arterial stiffness is increased in acute lacunar infarction. Considering the pathogenesis of lacunar infarction and the potential interconnected causes of arterial stiffness, our findings indicate that increased arterial stiffness in acute lacunar infarction may be related to the pathogenesis of lacunar infarction.

Panophthalmoplegia and vision loss after cosmetic nasal dorsum injection.

We report a case of unilateral blindness and panophthalmoplegia after hyaluronic acid injection into the dorsum of the nose in a healthy young woman. Microspheres of hyaluronic acid are popular fillers for facial rejuvenation. While ocular side effects from injections in the nose and face have been reported following turbinate injection, rhinoplasty and infraorbital nerve block, ocular side effects from injection into the dorsum of the nose are extremely rare. We presume that the symptoms were due to obstruction of the branches of the ophthalmic artery. Under high injection pressure, the microspheres travelled to the ophthalmic artery and were propelled by the blood flow to the central retinal artery and the anterior and posterior long ciliary arteries, leading to her symptoms. Alternatively, there are several arterio-venous anastomotic channels in the nasal mucosa that aid heat exchange. These may have been the conduit for reflux of the filler into the arterial side of the regional circulation. Physicians must remain aware of serious complications during cosmetic injections to this region.