Intracranial Migration of Silicone Delaying Life Saving Surgical Management: A Mimicker of Hemorrhage

Abstract

We present a case in which intraocular silicone injection for complex retinal detachment resulted in migration and distribution of silicone along the intracranial visual pathway, and ultimately throughout the ventricular system. Misinterpretation of this material as intracranial hemorrhage on outside computed tomography imaging delayed emergent repair of a Type A aortic dissection until the diagnosis was made on repeat imaging. A discussion of this case and salient computed tomography and magnetic resonance imaging characteristics of silicone is provided.

Intraocular Silicone Oil Implant Migration in a Patient with a Craniopharyngioma

“…The presence of intraocular silicone oil in the ventricles appears to be a benign finding. However, one of the biggest challenges is the ability to recognize its presence as this will save the patient from unnecessary procedures and will prompt essential medical treatment when necessary [11]. In the case of our patient the successful transnasal transsphenoidal resection of the craniopharyngioma lead to significant improvement of his right vision.…”

“…For these reasons intraocular silicone oil migration can be confused with intracerebral hemorrhage. To distinguish between intracerebral hemorrhage versus intraocular silicone oil migration one can rely on repeat imaging that will demonstrate a constant location for the intraocular silicone oil [11]. The exact mechanism for how intraocular silicone oil migrates from the eye to the cerebrospinal fluid (CSF) space is still not well understood.…”

Subarachnoid Contrast Hyperdensity Following Pelvic Trauma Mimicking Diffuse Subarachnoid Hemorrhage

“…Oh et al [13] describe a case of contrast enhancement of the subarachnoid space simulating SAH following lumbar percutaneous epidural neuroplasty (L-PEN). Sarohia et al [14] describe a case where the migration and distribution of silicone along the intracranial visual pathway and, eventually, the whole of the ventricular system resulted from an intraocular silicone injection for complex retinal detachment.…”

Scleral rupture during intraoperative silicone oil injection in pars plana vitrectomy

“…Migration through scleral wounds or glaucoma drainage devices into the subconjunctival and orbital space, and through the optic nerve into the brain, has been reported 13, 14, 15, 16, 17, 18. In addition to glaucoma, this can cause a direct toxic effect on the optic nerve in humans 19 and rabbits, 20 and its intracranial presence has been related to symptoms including seizures, headaches, dizziness, and nausea 21 . Silicone oil in the orbital cavity requires assessment by orbital and cerebral MRI, in consultation with a neurologist, because of the possibility of intracranial migration and toxicity.…”