An atypical presentation of cerebral fat embolism

Cerebral Large Vessel Occlusion Caused by Fat Embolism—A Case Series and Review of the Literature

“…In FES, the overall mortality is 10%, and most patients return to baseline function (8,33). In contrast, cases of LVO from fat emboli appear more neurologically severe compared to FES, with previous patient reports requiring decompressive hemicraniectomy for diffuse cerebral oedema (10,15,28,34). Endovascular clot retrieval is also emerging as a treatment option for these cases (2, 14, 22-26, 28, 35).…”

“…Of the 7 reported patients who underwent reperfusion therapy (ECR or STA-MCA bypass, excluding the patient who had unsuccessful ECR), 5 survived with reasonable function (modified Rankin scale 3 or better from case descriptions), one patient died due lack of clinical improvement, and another died due to intracranial haemorrhage shortly after ECR (2,14,(22)(23)(24)(25)(26). In comparison, of the patients who did not receive reperfusion therapy or received unsuccessful reperfusion therapy, five patients died, and two were functionally disabled (mRS 4) (10,15,17,18,21,27,28). The outcomes of 4 patients are unknown.…”

“…Of the spontaneous cases, one patient had a history of liposuction and gluteal augmentation 2 months prior, but this was presumed unrelated ( 2 ). One patient had LVO 9 days after Caesarean section, with multiple other embolic complications ( 28 ). Eleven of the 15 patients who did not have spontaneous LVO had onset of symptoms within 6 h of the presumed mechanism of injury ( 10 , 11 , 14 , 15 , 19 – 21 , 23 – 25 , 27 ).…”

“…Eleven of the 15 patients who did not have spontaneous LVO had onset of symptoms within 6 h of the presumed mechanism of injury ( 10 , 11 , 14 , 15 , 19 – 21 , 23 – 25 , 27 ). Four of the five patients who underwent PFO assessment were found to have a PFO ( 23 – 25 , 27 , 28 ). None of the patients had reported dermatologic manifestations, and only two patients had respiratory features ( 10 , 28 ).…”

“…Four of the five patients who underwent PFO assessment were found to have a PFO ( 23 – 25 , 27 , 28 ). None of the patients had reported dermatologic manifestations, and only two patients had respiratory features ( 10 , 28 ). With regards to treatment where it was available, one patient was treated with intravenous thrombolysis, eight patients underwent ECR or attempted ECR and three patients underwent decompressive hemicraniectomy.…”