Can the rate of mortality and neurological recovery be predicted from the time of onset of symptoms and MRI grade in patients with cerebral fat embolism?

Abstract

Aims The aim of this study was to assess whether it is possible to predict the mortality, and the extent and time of neurological recovery from the time of the onset of symptoms and MRI grade, in patients with the cerebral fat embolism syndrome (CFES). This has not previously been investigated. Methods The study included 34 patients who were diagnosed with CFES following trauma between 2012 and 2018. The clinical diagnosis was confirmed and the severity graded by MRI. We investigated the rate of mortality, the time and extent of neurological recovery, the time between the injury and the onset of symptoms, the clinical severity of the condition, and the MRI grade. All patients were male with a mean age of 29.7 years (18 to 70). The mean follow-up was 4.15 years (2 to 8), with neurological recovery being assessed by the Glasgow Outcome Scale and the Mini-Mental State Examination. Results In all, seven who had early-onset CFES (< 24 hours), and a severe Takahashi grade on MRI, died. There was a significant association between the time of onset of neurological signs and mortality (p = 0.035). Mortality was also significantly associated with a severe Takahashi grade (p < 0.001). Among the 27 surviving patients, 26 (96.3%) recovered completely. One (3.7%) had a cognitive deficit. The mean time to recovery was 4.7 weeks (2 to 13), with late recovery aftereight eight weeks being recorded in three patients. Conclusion There was a significantly increased rate of mortality in patients with CFES who had an early onset of symptoms and a severe grade on MRI. Complete neurological recovery can be expected in most patients with CFES who survive. Cite this article: Bone Joint J 2022;104-B(1):142–149.

Efficacy of early integrated rehabilitation therapy on treatment outcomes and limb functional recovery in patients with cerebral embolism: An observational study

“…[ 17 ] The efficacy of EIRT is derived from its holistic nature, addressing not only the physical impairments typically associated with cerebral embolism but also the cognitive and emotional aspects that significantly impact recovery. [ 18 ] By integrating various therapeutic modalities – physical therapy, occupational therapy, speech and language therapy, and psychological support – EIRT aims to provide a comprehensive, patient-centered care plan. [ 19 ] This integrated approach ensures that the multifaceted needs of each patient are met, promoting better overall outcomes and enhancing quality of life.…”

神経学的後遺症を残した電撃型脂肪塞栓症候群の1例～文献レビューと予後調査～(A case of fulminant fat embolism syndrome with neurological deficit: literature review and prognosis research)

“…FESにおける生命予後・神経学的後遺症発生の予測に関して，神経学的後遺症発生の予後予測についての報告は渉猟し得なかった。Takahashiら 9)は経時的に頭部MRIを撮影し，T2強調像でのMRI所見をgrade化し，FES発症時のGCSの点数がMRIのgradeと相関していたと報告したが，最終的な神経学的後遺症発生の予測には言及していない。死亡率に関しては神経症状の早期発症や前述のMRI gradeと相関していたとの報告があり 11)，電撃型FESの特徴である早期発症が高い死亡率を表していると推測される。また本研究でレビューを行った症例群を予後別に比較検討した結果，死亡群（19例）に対して，生存群（21例）は若年，男性，潜伏期間が長い症例が多かった（ 補足表3 ）。また神経学的後遺症に関しては差を認めなかった（ 補足表4 ）。…”

Occurrence of Numerous Cerebral White Matter Hyperintensities in Trauma Patients With Cerebral Fat Embolism: A Systematic Review and Report of Two Cases

“…Most included publications were case reports (21 publications) and three publications had relatively large datasets (patient numbers 24-39) [ 11 , 27 , 28 ]. When the MRI sequence was stipulated in the manuscript for detecting NCWMH (63 patients), the total number of patients in this review by sequence was DWI in 24, T2WI in 57, and FLAIR in 10 patients (Table 1 ).…”