Abstract 12995: Use of Percutaneous Septal Closure Device for Paradoxical Cerebral Fat Emboli in a Young Female With Patent Foramen Ovale

Abstract

Introduction: Cerebral fat emboli (CFE) is a rare (0.9-2.2%) and fatal complication (up to 10% mortality) after burst fractures of the long bones. Studies have reported a worse prognosis with the concomitant presence of a patent foramen ovale (PFO) by allowing a portal to reach systemic circulation, which could be preventable with closure devices; however, it remains unexplored. Clinical Case: 23-year-old female without any medical history, admitted to trauma ICU after a high-energy motor vehicle collision resulting in left femur open fracture, ribs, vertebral fractures, and left-sided pneumothorax. She was intubated due to poor mental status. CT head was unremarkable, but subsequent brain MRI showed multiple punctate foci of hyperintensity in the bilateral white matter of cerebral hemispheres, corpus collosum, cerebellum and brainstem, representing fat embolism (Figure). Transthoracic and transesophageal echocardiography confirmed a small PFO. After a multidisciplinary team discussion, PFO closure via Amplatzer device was done to reduce the risk of systemic embolism burden. Discussion: In patients with long bone fractures, right-to-left shunts from PFOs have been shown, by transcranial doppler (TCD), to be associated with larger and frequent micro embolic signals (MES) in the brain. TCD has also shown decreased embolic load and significant reductions in the size of emboli that make it to cerebral circulation after successful percutaneous closure of PFOs. Similar results are seen in prospective high-risk long bone fractures before orthopedic interventions. This suggests there could be a potential role of closure devices in such trauma patients with PFO. Conclusion: There could be a potential role of closure devices in selected trauma patients with paradoxical cerebral embolism and a PFO, however, the benefits of long-term outcomes need to be explored in larger cohorts.