Objective:

To present a unique and rare neuro-radiological finding of intracranial silicone oil migration mimicking intracerebral hemorrhage.

Background:

Since the introduction of silicone oil for retinal detachment in 1962, limited reports have detailed its migration from the eye's vitreous chamber to the optic nerve, optic chiasm, and brain ventricular system. On imaging, silicone oil appears as a hyperattenuating mass, often confused with intracerebral hemorrhage or neoplasm. The mechanism of silicone oil dispersion and concentration in specific intracranial sites is not fully understood. Proposed factors include emulsification and increased intraocular pressure, with potential routes through the lamina cribrosa or congenital abnormalities. Preexisting glaucoma, optic nerve damage, and orbital trauma may contribute. 

Design/Methods:

Case Report

Results:

A young male with a complex medical history of hypertension, uncontrolled diabetes complicated by end-stage renal disease, retinopathy (legally blind), and foot ulcers s/p toe amputations, presented with confusion and multiple falls. CT head revealed rounded hyperdensity in the frontal horn of the lateral ventricles, suspicious for acute hemorrhage, and a hyperattenuating focus in the suprasellar cistern, potentially involving the optic nerve, raising suspicion for optic nerve glioma, meningioma, or hemorrhage. Subsequent MRI identified the above findings as related to intracranial silicone oil migration originating from the right globe.

Conclusions:

Patients presenting with stroke-like symptoms and findings resembling intraventricular hemorrhage on CT imaging may experience delays in critical decision-making, such as thrombolytics administration, due to the misinterpretation of radiological findings. Recognizing this rare phenomenon is essential, especially in individuals with a history of ocular conditions, to prevent misdiagnosis and guide appropriate treatment. Although rare, clinicians should be aware of the potential for silicone oil migration to mimic intracerebral hemorrhage or neoplasms on imaging, which can significantly impact the management of stroke patients eligible for Thrombolysis.