Abstract：
BACKGROUND: Poly-D, L-lactic acid (PDLLA) is increasingly used as a commercial dermal filler due to its lasting cosmetic properties. Consequently, PDLLA-related vascular complications are increasingly recognized and described. Herein, we describe the first known occurrence of multifocal strokes from the use of PDLLA as a cosmetic dermal filler, and discuss the mechanisms facilitating PDLLA\'s entry into the intracranial arterial system.
METHODS: A middle-aged female presented with acute vision loss of both eyes immediately after dermal injections of PDLLA to her nasolabial folds and infraorbital regions. There were no additional neurological deficits. Dilated fundal examination revealed retinal edema bilaterally, with deposition of filler material in the retinal arteries. Magnetic resonance imaging of her brain and orbits demonstrated multifocal strokes (left caudate head, right medial frontal lobe) and ischemia of the left optic nerve. The temporal proximity of the dermal injections to her symptoms, guided by fundal examination and neuroimaging findings, allowed us to attribute her strokes and ischemic optic neuropathy to PDLLA\'s entry into, and embolism within, the intracranial arterial system. She was treated with hyperbaric oxygen therapy and experience improvement to her right eye\'s vision, although poor vision persisted in her left eye.
CONCLUSIONS: While PDLLA is generally considered safe, its increasing use as a cosmetic filler renders it crucial for physicians to be cognizant of its vascular complications, especially when early recognition and treatment are essential in mitigating their devastating ramifications.
METHODS: A middle-aged female presented with acute vision loss of both eyes immediately after dermal injections of PDLLA to her nasolabial folds and infraorbital regions. There were no additional neurological deficits. Dilated fundal examination revealed retinal edema bilaterally, with deposition of filler material in the retinal arteries. Magnetic resonance imaging of her brain and orbits demonstrated multifocal strokes (left caudate head, right medial frontal lobe) and ischemia of the left optic nerve. The temporal proximity of the dermal injections to her symptoms, guided by fundal examination and neuroimaging findings, allowed us to attribute her strokes and ischemic optic neuropathy to PDLLA\'s entry into, and embolism within, the intracranial arterial system. She was treated with hyperbaric oxygen therapy and experience improvement to her right eye\'s vision, although poor vision persisted in her left eye.
CONCLUSIONS: While PDLLA is generally considered safe, its increasing use as a cosmetic filler renders it crucial for physicians to be cognizant of its vascular complications, especially when early recognition and treatment are essential in mitigating their devastating ramifications.
摘要：
背景：Poly-D，L-乳酸(PDLLA)由于其持久的化妆品性质而越来越多地用作商业皮肤填充剂。因此,PDLLA相关的血管并发症越来越被认识和描述。在这里，我们描述了使用PDLLA作为化妆品真皮填充剂的多焦点中风的第一个已知发生，并讨论了PDLLA进入颅内动脉系统的机制。
方法：一名中年女性在鼻唇沟和眶下区域皮肤注射PDLLA后立即出现双眼急性视力丧失。没有额外的神经缺陷。扩张眼底检查提示双侧视网膜水肿，填充材料沉积在视网膜动脉中。她的大脑和轨道的磁共振成像显示了多灶性中风（左尾状头，右内侧额叶）和左视神经缺血。皮肤注射与她的症状暂时接近，以眼底检查和神经影像学检查为指导，允许我们将她的中风和缺血性视神经病变归因于PDLLA进入，和栓塞，颅内动脉系统.她接受了高压氧治疗，右眼视力得到改善，尽管她的左眼视力不佳。
结论：虽然PDLLA通常被认为是安全的，它越来越多地用作化妆品填料，使得医生认识到它的血管并发症至关重要，特别是早期识别和治疗对于减轻其破坏性影响至关重要。
方法：一名中年女性在鼻唇沟和眶下区域皮肤注射PDLLA后立即出现双眼急性视力丧失。没有额外的神经缺陷。扩张眼底检查提示双侧视网膜水肿，填充材料沉积在视网膜动脉中。她的大脑和轨道的磁共振成像显示了多灶性中风（左尾状头，右内侧额叶）和左视神经缺血。皮肤注射与她的症状暂时接近，以眼底检查和神经影像学检查为指导，允许我们将她的中风和缺血性视神经病变归因于PDLLA进入，和栓塞，颅内动脉系统.她接受了高压氧治疗，右眼视力得到改善，尽管她的左眼视力不佳。
结论：虽然PDLLA通常被认为是安全的，它越来越多地用作化妆品填料，使得医生认识到它的血管并发症至关重要，特别是早期识别和治疗对于减轻其破坏性影响至关重要。
