Left middle cerebral artery territory infarction due to intravitreal injection of ranibizumab

Abstract

Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is increasingly used for the treatment of a wide variety of retinal diseases including age-related macular degeneration, diabetic retinopathy and retinal vascular occlusions, and retinopathy of prematurity. Despite encouraging results in halting the disease and improving the vision, intravitreal injection of anti-VEGF agents may be associated with marked side effects. The present case describes a 75-year-old female with known complications of hypertension, Type II DM, and hypothyroidism, who received intravitreal injections of Lucentis (ranibizumab) due to diabetic macular edema. After 10 days, the patient admitted with chief complaints of slurred speech. Further, radiological and clinical investigations conferred the case to be a left middle cerebral artery territory infarct with right-sided hemiparesis and aphasia. Although well-designed randomized clinical trials have shown the efficacy of these agents in visual improvement in various retinal diseases, each intravitreal injection poses the risk of postinjection- and drug class-associated adverse events. Clinicians should be more vigilant as patients receiving intravitreal injections are at a small risk of developing complications, which is often unrecognized or underreported.