Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Embolic stroke immediately after initial administration of intravitreal aflibercept

Hironori Mizutani, M.D.1)2), Yuichiro Inatomi, M.D.1), Takaomi Singu, M.D.1), Makoto Nakajima, M.D.2), Toshiro Yonehara, M.D.1) and Yukio Ando, M.D.2)

1)Department of Neurology, Saiseikai Kumamoto Hospital
2)Department of Neurology, Graduate School of Medical Sciences, Kumamoto University

A 72-year-old man was admitted to our hospital because of right upper limb monoplegia 8 hours after the initial intravitreal injection of aflibercept, which is an inhibitor of vascular endothelial growth factor. Magnetic resonance diffusion-weighted images showed recent ischemic lesions in the left corona radiata and the right superior frontal gyrus. Laboratory findings showed mild hyperfibrinolysis. A patent foramen ovale was diagnosed on transesophageal echocardiography; however, lower-extremity ultrasonography did not detect deep vein thrombosis. The source of embolism remained unknown. A possible mechanism of cerebral emboli in the present case was a rapidly induced hypercoagulative state due to transfer of aflibercept from the vitreous body to the systemic circulation.
Full Text of this Article in Japanese PDF (441K)

(CLINICA NEUROL, 58: 314|319, 2018)
key words: anti-vascular endothelial growth factor therapy, brain embolism, age-related macular degeneration, intravitreal injection, hypercoagulative state

(Received: 27-Feb-18)