INTRODUCTION: Ischaemic stroke is a severe complication of dermal filler injections that remains poorly described and understood. This study aims to characterise the clinical features and outcomes of patients who experience strokes following facial dermal filler injections. METHOD: A systematic review and retrospective analysis of ischaemic strokes caused by dermal filler injections and reported over the past 3 decades, were conducted. Cases involving autologous fat were also compared against those that did not. RESULTS: Fifty-five cases from 45 studies were analysed. Their median age was 32 years (18-61), and most were women (49/55, 89%). Injections frequently occurred at the glabella (17/53, 32%) and temples (12/53, 23%), and autologous fat was most often used (33/55, 60%). Half (29/55, 53%) had ocular symptoms at presentation. Hemiparesis/hemiplegia (30/55, 55%) and confusion/ reduced consciousness/alertness (26/55, 47%) were the predominant stroke symptoms. Most infarcts were unilateral (45/54, 83%) and large (32/48, 67%). Treatment primarily involved corticosteroids (12/41, 29%) and antiplatelet agents (11/41, 27%), while hyaluronidase injections (3/41, 7%) and hyperbaric oxygen therapy (2/41, 5%) were rarely used. Less than half (22/55, 40%) experienced good functional recovery. Those injected with autologous fat were likelier to be symptomatic from their strokes (100% versus [vs] 68%, P=0.0012), develop larger strokes (93% vs 24%, P<0.0001) and experience non-ambulatory outcomes (44% vs 73%, =0.0381). CONCLUSION Strokes are rare complications of dermal fillers. Injections using autologous fat risk larger strokes and worse ambulatory outcomes. An hour of post-procedural observation appears reasonable, and those with ocular complications should undergo brain imaging even in the absence of stroke symptoms.
Humans ; Dermal Fillers/administration & dosage* ; Female ; Ischemic Stroke/chemically induced* ; Adult ; Cosmetic Techniques/adverse effects* ; Retrospective Studies ; Middle Aged ; Male ; Face ; Adolescent ; Young Adult

INTRODUCTION: Uterine rupture is uncommon but has catastrophic implications on the pregnancy. A scarred uterus and abnormal placentation are known contributory factors. The aim of our study was to review the contributing factors, clinical presentation, complications and management of uterine rupture in our population in light of the changing nature of modern obstetric practices. METHODS: A retrospective observational study was conducted at KK Women's and Children's Hospital by studying proven cases of uterine rupture in the period between January 2003 and December 2014. These cases were analysed according to their past history, clinical presentation, complications, management and outcome. RESULTS: A total of 48 cases of proven uterine rupture were identified. The incidence of uterine rupture was 1 in 3,062 deliveries. The ratio of scarred uterus rupture to unscarred uterus rupture was approximately 3:1. The most common factor was previous lower segment caesarean section for the scarred group, followed by a history of laparoscopic myomectomy. Abdominal pain was the common clinical presentation in the antenatal period, while abnormal cardiotocography findings were the most common presentation in intrapartum rupture. CONCLUSION There is a notable shift in the trend of uterine rupture cases given the increasing use of laparoscopic myomectomy and elective caesarean sections. While ruptures from these cases were few, their presentation in the antenatal period calls for diligent monitoring with informed patient involvement in their pregnancy care.