Delayed onset of fat embolus in the cerebral venous system after breast and hip augmentation: a case report

Abstract

Background Cerebral fat embolism (CFE) is a subtype of fat embolism syndrome which tends to cause ischemic cerebral infarction. Fat embolism in the cerebral venous system have not been reported. We hereby present a rare case of fat embolus formed in the cerebral venous system 10 days after cosmetic surgery, and describe our management of this patient. Case presentation A 26-year-old woman with the disturbance of consciousness and recurrent convulsions of the right upper extremity over a 21-h period was admitted to our hospital. The patient was initially diagnosed with haemorrhagic infarction, and cerebral venous thrombosis (CVT) was suspected based on computed tomography (CT). A diagnosis of CFE was confirmed based on surgical findings. Breast and hip augmentation performed 10 days ago was considered the underlying cause. Drug-induced hypothermia, low molecular weight heparin, atorvastatin, dexamethasone, piperacillin/tazobactam, valproic acid, and mannitol were applied. On hospital day 30, she was discharged with a Montreal Cognitive Assessment score of 25. Conclusions Fat embolism can occur in the cerebral venous system, and may mimic CVT symptoms rather than CFE symptoms. Early identification of the nature of the embolus is essential. The use of heparin may prevent secondary thrombus formation, and accelerate fat embolus decomposition.

Fat embolism: the hidden murder for trauma patients!

“… Case Underlying Cause Main Clinical Presentation Main Radiological Findings Diagnostic Tool Treatment Outcome Kadar et al 2021 25 Elective Liposuction -Respiratory failure -Altered mental status -Tachycardia -Low O2 saturation -ECG: right axis deviation and ST-T changes -CT: bilateral diffuse ground-glass lung opacities -Brain CT: diffuse edema and infarction Bronchoa veolar lavage (BAL) Positive airway pressure, antibiotics, intubation, and mechanical ventilation Patient transferred from ICU to general medicine unit on hospital day 7 with moderate cognitive impairment which improved after 1 month follow-up. Dong et al 2021 26 Trauma craniotomy after breast and hip augmentation -disturbance of consciousness -convulsion of right upper extremity -intracranial hypertension no chest CT or echocardiogram abnormalities Fat embolus found during trauma craniotomy Transfer to neuro ICU after surgery. Patient discharged on hospital day 30 with regained cognitive function.…”