Case report: Acute postoperative neurological impairment from fat embolism syndrome

Abstract

Purpose: To describe a case of fat embolism syndrome (FES) following elective tendon contracture release in a patient with myotonic dystrophy, to highlight the importance of considering this entity in the differential diagnosis of acute postoperative neurocognitive dysfunction. Clinical features:A 34-yr-old man with myotonic dystrophy underwent uneventful tendon contracture release under regional anesthesia. In the immediate postoperative period, neurological and respiratory complications developed, requiring intensive care support. The patient showed the classical clinical triad of hypoxemia, neurological impairment and a petechial rash associated with the FES. A diagnosis of FES was made and, despite therapy including fluid and inotropic support, the patient succumbed to the condition. There was no demonstrated intracardiac shunt, suggesting a physiological intrapulmonary shunt was responsible for the development of systemic manifestations of FES. Conclusions:Postoperative neurological dysfunction is a difficult condition with numerous possible causes. All possible etiologies, including FES, need to be considered in the differential diagnosis and postoperative management of patients developing acute postoperative neurological impairment and hypoxemia. U NRESOLVING postoperative neurocognitive dysfunction is a serious complication following surgery. The acute postoperative period is a critical time when significant neurological changes can be difficult to detect, and as a result of multiple potential etiologies and contributing factors, diagnosis and appropriate management can sometimes be delayed. We present a case of acute postoperative neurological dysfunction resulting from fat embolism syndrome 296 CAN J ANESTH 54: 4 www.cja-jca

Early onset fat embolism syndrome: Case report and literature review

“…3,4,16 The syndrome may present across a spectrum from subclinical features to a fulminant course, including a cerebral form, which carries higher mortality. 10,11,16,19 The incidence is said to be higher in closed compared to open fractures. 6 Our patient had a closed fracture.…”

Transcranial Doppler Detection of Cerebral Fat Emboli and Relation to Paradoxical Embolism

“…11,[23][24][25][26][27] However, FES can occur without a PFO, as previously reported by us and others. 11,24,28,29 This could mean that another mechanism must be involved in the pathophysiology of FES besides paradoxical embolism through a PFO. Our findings suggest that patients with an RLS may have more frequent and severe neurological symptoms than those without an RLS, but this possibility needs to be confirmed in future studies.…”