Isolated Cerebral Fat Emboli Syndrome in Multiply Injured Patients: A review of Three Cases and the Literature

Meyer, Nicholas; Pennington, William T.; Dewitt, David; Schmeling, Gregory J

doi:10.1097/01.ta.0000223953.05151.96

Cited by 21 publications

(34 citation statements)

References 47 publications

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“…Our patient underwent an orthopaedic procedure that did not offend the medullary cavity which is usually the source of embolism whereby the intramedullary fat enters the systemic circulation 16. Moreover, the underlying condition of our patient, dystonia musculorum deformans or torsion dystonia is characterised by sustained muscle contractions and twisting movements with abnormal body postures and not with increased risk of FES or fat in the bloodstream 17 18.…”

Section: Discussionmentioning

confidence: 91%

“…In addition, there were also reports of FES following spinal arthrodesis and augmentation of spine pedicle screws with bone cement resulting in fulminating pulmonary fat embolism 1–3. There were also reports of isolated cerebral fat emboli syndrome with subtle clinical signs and were diagnosed by MRI and CT changes 16. Both major and minor features could also be present in other concomitant conditions.…”

Section: Discussionmentioning

confidence: 99%

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Fat embolism syndrome in a child with dystonia musculorum deformans

Ng¹,

Chow²,

To³

2012

Case Reports

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A 16-year-old boy with dystonia musculorum deformans underwent an operation for removal of femoral implants and excision of the prominence at the greater trochanter of the left hip. He was found to have fat embolism syndrome at postoperative day 1 as evidenced by confusion, respiratory symptoms, chest radiograph changes, raised erythrocyte sedimentation rate, thrombocytopenia and fat in the urine and sputum.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Fat embolism syndrome in a child with dystonia musculorum deformans

Ng¹,

Chow²,

To³

2012

Case Reports

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“…The most widely accepted theory was initially proposed by Bergman et al in 1873: mechanical occlusion of the microvascular bed by fatty emboli is the central event that precipitates all of the syndrome compo nents in each individual organ. 37 This finding of mechani cal occlusion was originally described in the pulmonary vasculature, but we now know of several mechanisms that explain how the fat globules bypass the pulmonary circula tion and reach other organs, triggering the systemic effects of FES. The filtration ability of the lungs is approximately 80%; smaller fat droplets 7-10 mm in diameter will pass through the capillaries.…”

Section: Discussionmentioning

confidence: 99%

“…Given that most patients with FES exhibit symptoms in the first 48 hours, it is imperative to exclude other treatable causes of neuro logical decline, such as increasing cerebral contusions or diffuse brain injury with swelling. 37,53 In the largest study of cerebral FES to date, Takahashi et al 51 suggested, for the first time, incorporating neuroimaging characteristics into the diagnostic criteria, which was finally accom plished by Lee et al 33 in 2012 with the creation of Gurd's modified criteria, an approach that we also favor.…”

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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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“…The reported incidence of fat embolism syndrome in long bone fractures is 0.5-11% and up to 30% in bilateral femoral fractures 345. Cerebral fat embolism syndrome where the clinical manifestation is dominated by neurological dysfunction is rare and only scarcely reported.…”

Section: Introductionmentioning

confidence: 99%

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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Isolated Cerebral Fat Emboli Syndrome in Multiply Injured Patients: A review of Three Cases and the Literature

Cited by 21 publications

References 47 publications

Fat embolism syndrome in a child with dystonia musculorum deformans

Fat embolism syndrome in a child with dystonia musculorum deformans

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management

Late recovery in cerebral fat embolism

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