Case Of Cerebral Fat Embolism Research Articles

P.057 A case of cerebral fat embolism in the absence of right-to-left shunt

Background: A 64-year-old man underwent an elective right total hip arthroplasty. Post-operatively, his GCS was 6, despite reversal of anesthetic agents. His toes were upgoing bilaterally. He did not have other focal neurologic deficits. He was intubated for airway protection. His only vascular risk factor was hypertension. Methods: [Case Report]Results: A CT/CTA/CTP head was unremarkable. A 1.5T MRI showed a few tiny, bihemispheric, embolic infarcts. These were not significant enough to account for his decreased level of consciousness. His blood work did not show evidence of coagulopathy. A subsequent 3T MRI demonstrated widespread, tiny embolic infarcts in a starfield pattern, consistent with cerebral fat embolism. A transesophageal echocardiogram with bubble study failed to demonstrate a right-to-left shunt. By post-operative day 11, he returned to his neurological baseline. Conclusions: A high degree of suspicion is required to diagnose cerebral fat embolism. There are reports of cerebral fat embolism in the absence of right-to-left shunt. The proposed mechanism is physiologic stress leading to systemic release of free fatty acids and inflammatory mediators, which damage capillary beds and disrupt the blood-brain barrier. This diagnosis has important prognostic implications as fat vacuoles deform easily and deficits are typically more reversible than those occurring with other embolic events.

A Case of Cerebral Fat Embolism

A Case of Cerebral Fat Embolism

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management

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 intracranial pressure (ICP). They also discuss the literature as well as the potential need for neurosurgical management of this disease entity in select patients. A 58-year-old 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 gray-white 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 T2-hyperintense 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 hemicraniectomy. 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 seizure. 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.

Computed tomographic findings of cerebral fat embolism following multiple bone fractures

Fat embolism to the lungs and brain is an uncommon complication following fractures. Few reports with descriptions of computed tomographic (CT) findings of emboli to the brain or cerebral fat embolism are available. We report a case of cerebral fat embolism following multiple skeletal fractures and present its CT findings here.

Susceptibility-Weighted Imaging of Cerebral Fat Embolism

Cerebral fat embolism (CFE) causes microinfarcts, vasogenic edema, and petechiae in the brain. Conventional magnetic resonance imaging has been reported to effectively visualize microinfarcts and vasogenic edema in CFE, but not petechiae. We report 3 cases of CFE in which susceptibility-weighted imaging distinctly demonstrated multiple minute hypointense foci in the brain, which were interpreted as petechiae, susceptibility-weighted imaging is a useful adjunct to conventional magnetic resonance imaging for the evaluation of CFE.

Gradient-Echo MRI in Defining the Severity of Cerebral Fat Embolism

BackgroundA few studies have found that abnormal findings on diffusion-weighted magnetic resonance imaging (MRI) are useful for diagnosing cerebral fat embolism in the acute stage.Case ReportWe applied serial MRI to a case of cerebral fat embolism with cognitive impairment lasting for 2 months. Although marked resolution of the previous abnormal findings was demonstrated, T2*-weighted gradient-echo MRI revealed multiple tiny lesions.ConclusionsWe suggest that T2*-weighted gradient-echo MRI is useful in defining the clinical severity of patients with cerebral fat embolism.

Cerebral Fat Embolism after External Fixation of Open Ankle Fracture in a Patient with Multiple Fracture: A case report

Even though cerebral fat embolism develops rarely after long bone fracture, it may be very important complication because it can be fatal and the early detection is not easy. Neurologic symptoms include confusion, restlessness, disorientation, seizure, and stroke with focal deficits. High intensive T2 signal MRI of the brain is most sensitive for diagnosis of cerebral fat embolism. We report a case of cerebral fat embolism diagnosed after external fixation of ankle open fracture in a 46 year old woman patient with multiple fracture.

Cerebral fat embolism: Usefulness of magnetic resonance spectroscopy

We report a case of cerebral fat embolism which occurred in a 33-year-old man after a diaphyseal femoral fracture without cranial traumatism. The initial examination showed an incomplete picture of coma with tetrapyramidal syndrome and cutaneomucous purpura. There was no respiratory damage. We present a magnetic resonance spectroscopy analysis of the cerebral lesions observed in the initial phase of the embolism, as well as follow-up, which has strengthened the clinical and imaging features for the diagnosis.

Magnetic resonance imaging of cerebral fat embolism: A case report

Fat embolism syndrome (FES) is one of the most important causes of morbidity and mortality following multiple fractures. Neurological involvement (cerebral fat embolism) has been reported frequently. A case of cerebral fat embolism is reported. While CT scan revealed no abnormalities, MRI, performed in this patient 8 days after trauma, showed relative low-intensity areas on T1-weighted images and high intensity areas on T2-weighted images involving cerebral white matter, corpus callosum and basal ganglia. MRI follow-up (1 and 3 months post-trauma) showed nearly complete resolution of the abnormal signal. MRI seems to be a useful diagnostic tool for detecting and quantifying lesions in fat embolism syndrome.