Delayed coma in head injury: Consider cerebral fat embolism

Metting, Zwany; Rödiger, Lars A.; Regtien, Joost G.; Naalt, Joukje van der

doi:10.1016/j.clineuro.2009.03.005

Cited by 22 publications

(19 citation statements)

References 14 publications

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“…Cerebral fat embolism has been reported in young adults between 18 and 39 years 561012131415161718192021. The two patients, we report here are also in the same age group.…”

Section: Discussionsupporting

confidence: 65%

“…Although, neurological deterioration in many reported patients was postoperative following intramedullary nailing for long bone fractures;561013141516 onset prior to surgery has also been reported as seen in our patients 101217181920. MRI is helpful in diagnosis of cerebral fat embolism and also to exclude other causes of deterioration 121721. Parizel et al 19.…”

Section: Discussionmentioning

confidence: 54%

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Late recovery in cerebral fat embolism

Sundararajan

Rajasekaran

2014

IJOO

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Fat embolism syndrome presenting primarily with cerebral manifestations is rarely reported. We report here two such patients who showed complete recovery following initial deterioration. The aim of these reports is to highlight that prolonged intensive care and good rehabilitation can lead to normal neurologic recovery despite poor clinical picture initially. The importance of adequate oxygenation to prevent secondary brain damage is emphasized during prolonged recovery.

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“…Cerebral fat embolism has been reported in young adults between 18 and 39 years 561012131415161718192021. The two patients, we report here are also in the same age group.…”

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 54%

Late recovery in cerebral fat embolism

Sundararajan

Rajasekaran

2014

IJOO

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“…It should be emphasized that cerebral fat embolism has been reported in the absence of a patent foramen ovale [9,10]. Clinical diagnosis of cerebral fat embolism may be aided by Gurd's diagnostic criteria [11], and should be suspected in trauma patients with long-bone fractures and otherwise unexplained neurological deterioration [12,13]. Imaging with head CT typically does not reveal abnormalities [14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Improvement Following Cerebral Fat Emboli

2010

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“…The filtration ability of the lungs is approximately 80%; smaller fat droplets 7-10 mm in diameter will pass through the capillaries. 36 Furthermore, a patent foramen ovale is present in 20%-25% of the normal population.…”

Section: Discussionmentioning

confidence: 99%

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management

Kellogg¹,

Fontes²,

Lopes³

2013

JNS

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Fat embolism syndrome (FES) is a common clinical entity that can occasionally have significant neurological sequelae. The authors report a case of cerebral fat embolism and FES that required surgical management of intracra nial pressure (ICP). They also discuss the literature as well as the potential need for neurosurgical management of this disease entity in select patients. A 58yearold woman presented with a seizure episode and altered mental status after suffering a right femur fracture. Head CT studies demonstrated hypointense areas consistent with fat globules at the graywhite matter junction predominantly in the right hemisphere. This CT finding is unique in the literature, as other reports have not included imaging performed early enough to capture this finding. Brain MR images obtained 3 days later revealed T2hyperintense areas with restricted diffusion within the same hemisphere, along with midline shift and subfalcine herniation. These findings steered the patient to the operating room for decompressive hemicraniec tomy. A review of the literature from 1980 to 2012 disclosed 54 cases in 38 reports concerning cerebral fat embolism and FES. Analysis of all the cases revealed that 98% of the patients presented with mental status changes, whereas only 22% had focal signs and/or seizures. A good outcome was seen in 57.6% of patients with coma and/or abnormal posturing on presentation and in 90.5% of patients presenting with mild mental status changes, focal deficits, or sei zure. In the majority of cases ICP was managed conservatively with no surgical intervention. One case featured the use of an ICP monitor, while none featured the use of hemicraniectomy.

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Delayed coma in head injury: Consider cerebral fat embolism

Cited by 22 publications

References 14 publications

Late recovery in cerebral fat embolism

Late recovery in cerebral fat embolism

Clinical and Radiographic Improvement Following Cerebral Fat Emboli

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management

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