Systemic fat embolism. A diagnostic profile in 24 patients.

Abstract

In a series of 24 patients with systemic fat embolism, clinical signs commenced within 12 hours of the trauma in one third and within 24 hours in two thirds of the cases. Impairment of consciousness was the most common finding. The neurologic manifestations usually were bilateral and symmetric, being chiefly pyramidal signs, epileptic seizures, and decerebrate rigidity. Thirty percent of the patients also had focal neurologic deficit. Sudden onset of fever, tachycardia, and tachypnea was common, whereas roentgenographic evidence of pulmonary fat embolism was noted in only one of every three patients. Petechial hemorrhages, signs of retinal fat embolism, lipuria, and a major decrease in hemoglobin level were found in half the patients. Seven of the 24 patients died, all within 96 hours and all in deep coma. Survival for longer than four days carried a good prognosis. Treatment with massive doses of steroids may be useful.