Cerebral fat embolism without intracardiac shunt: A novel presentation

Eriksson, Evert A.; Schultz, Sarah E.; Cohle, Stephen D.; Post, Kenneth W

doi:10.4103/0974-2700.82233

Cited by 28 publications

(22 citation statements)

References 20 publications

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“…[32] However, patients have been reported to progress to brain death following cerebral fat embolism. [33] Residual neurological deficits may range from subtle personality changes to memory loss, cognitive dysfunction and long term focal deficits. [34] FES alone has not yet been reported to cause global anoxic injury, but it may play a contributory role, acting along with other cerebral insults.…”

Section: Discussionmentioning

confidence: 99%

Fat embolism syndrome in long bone trauma following vehicular accidents: Experience from a tertiary care hospital in north India

et al. 2013

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Background:Fat embolism syndrome (FES) is a clinical problem arising mainly due to fractures particularly of long bones and pelvis. Not much literature is available about FES from the Indian subcontinent.Materials and Methods:Thirty-five patients referred/admitted prospectively over a 3-year period for suspected FES to a north Indian tertiary care center and satisfying the clinical criteria proposed by Gurd and Wilson, and Schonfeld were included in the study. Clinical features, risk factors, complications, response to treatment and any sequelae were recorded.Results:The patients (all male) presented with acute onset breathlessness, 36-120 hours following major bone trauma due to vehicular accidents. Associated features included features of cerebral dysfunction (n = 24, 69%), petechial rash (14%), tachycardia (94%) and fever (46%). Hypoxemia was demonstrable in 80% cases, thrombocytopenia in 91%, anemia in 94% and hypoalbuminemia in 59%. Bilateral alveolar infiltrates were seen on chest radiography in 28 patients and there was evidence of bilateral ground glass appearance in 5 patients on CT. Eleven patients required ventilatory assistance whereas others were treated with supportive management. Three patients expired due to associated sepsis and respiratory failure, whereas others recovered with a mean hospital stay of 9 days. No long term sequelae were observed.Conclusion:FES remains a clinical challenge and is a diagnosis of exclusion based only on clinical grounds because of the absence of any specific laboratory test. A high index of suspicion is required for diagnosis and initiating supportive management in patients with traumatic fractures, especially in those having undergone an invasive orthopedic procedure.

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Section: Discussionmentioning

confidence: 99%

Fat embolism syndrome in long bone trauma following vehicular accidents: Experience from a tertiary care hospital in north India

et al. 2013

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“…Cranial MRI is more sensitive than CT imaging. T2 weighted and diffusion weighted MRI shows small hyper intense punctate lesions in the cerebral white matter, cerebellum and brain stem (3,(5)(6)(7). In this patient, cranial CT and cranial MRI studies were performed.…”

Section: Discussionmentioning

confidence: 94%

Diffusion Weighted MRI May be a Life Saving Tool in Cerebral Fat

Mete¹,

Savran²,

Duransoy³

et al. 2012

Turk J Anesth Reanim

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Cerebral fat embolism syndrome is a rare, but potentially lethal, complication of long bone fractures. Neurological symptoms are variable, the clinical diagnosis is difficult and occurs in only 0.9-2.2% of these cases. A 19 yearold male with no head injury suffered 3 epileptic seizures 17 hours after left femoral shaft and left tibia fractures. He had hypoxia. Chest x-ray and thoracic computed tomography (CT) were normal. T2 and diffusion weighted magnetic resonance imaging (MRI) showed multiple hyperintesity within the bilateral basal ganglia. We thought that this indicated areas with multiple microemboli. He was intubated after clinical deteriotation. Heparin, acetylsalicylic acid, mannitol and corticosteroids were administered, he was operated on next morning for left femoral shaft and left tibia fractures and he showed neurological improvement after 24 hours. Diffusion weighted MRI of the brain should become the first step in the diagnostic algorithm of cerebral fat embolism and patients have neurological improvement with early diagnosis and appropriate management. Serebral Yağ Emboli Sendromu; uzun kemik kırıklarına bağlı ortaya çıkan nadir ve öldürücü bir komplikasyondur.Nörolojik semptomlar değişken olup klinik tanısı zor ve hastaların %0,9-2,2 sinde görülür. Burada 19 yaşında kafa travması olmaksızın sol femoral şaft ve tibia kırıkları olan, travma sonrası 17. saatte 3 kez epileptik nöbeti olan erkek hasta sunulmuştur. Hastanın hipokisi mevcuttu. Çektirilen PA-AC grafisi ve AC tomografisi normaldi. T2 ve Difüzyon MRG'lerde multipl bilateral bazal ganglionlarda hiperintens lezyonlar saptandı. Bu görünümün multipl mikroembolilere bağlı olduğunu düşündük. Hasta klinik kötüleşme sonrası entübe edildi. Hastaya heparin, asetilsalisilik asit, mannitol ve kortikosteroid uygulandı. Ertesi gün sol femoral şaft kırığı ve tibia kırığı için opere edilen hastada klinik düzelme görüldü. Difüzyon MRG Serebral Yağ Embolisi tanı algoritminde ilk basamakta düşünülmelidir. Bu tür hastalar erken tanı ve uygun tedavi ile nörolojik düzelme göstermektedir. Abstract / ÖzetCase Report / Olgu Sunumu

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“…The major triad is hypoxia, neurologic symptoms and petechial rash. The minor findings are tachycardia, fever, anemia, and thrombocytopenia (2,4,10). Respiratory symptoms which occur before the neurologic symptoms include hypoxia, tachypnea, and dyspnea.…”

Section: Discussionmentioning

confidence: 98%

Serebral Yağ Embolisinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntüleme

Kural¹,

Dönmez²,

Aslan³

et al. 2012

Tnd

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Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si:Fat embolism syndrome (FES) is primarily associated with long bone fractures of the lower extremities. FES typically occurs between 1 and 3 days after the trauma, and the clinical triad is hypoxia, neurologic symptoms and petechial rash. Neurologic symptoms vary widely from confusion to coma, and in rare instances death may occur. Magnetic resonance imaging is the most effective method used to diagnose cerebral FES. Typical findings are multiple punctate hyperintensities in the subcortical and deep white matter on T2 weighted and diffusion-weighted images. This is known as a starfield pattern. This paper discusses a case of cerebral FES in a patient who had neurologic symptoms after traumatic femur neck facture. (Turkish Journal of Neurology 2012; 18:108-10)

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Cerebral fat embolism without intracardiac shunt: A novel presentation

Cited by 28 publications

References 20 publications

Fat embolism syndrome in long bone trauma following vehicular accidents: Experience from a tertiary care hospital in north India

Fat embolism syndrome in long bone trauma following vehicular accidents: Experience from a tertiary care hospital in north India

Diffusion Weighted MRI May be a Life Saving Tool in Cerebral Fat

Serebral Yağ Embolisinde Difüzyon Ağırlıklı Manyetik Rezonans Görüntüleme

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