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Gui XY, Ahmad W, Ali I. A Fatal Case of Cerebral Fat Embolism: A Case Report. Cureus 2024; 16:e59107. [PMID: 38803752 PMCID: PMC11128378 DOI: 10.7759/cureus.59107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Fat embolism syndrome (FES) is a rare but serious multisystem syndrome that occurs after 0.9% to 2.2% of fractures, with long bone and pelvic fractures being the most common. The classic triad of FES consists of neurological impairment, respiratory insufficiency, and petechial rash, which develops 12-72 hours after the initial incident. We hereby present a case of a patient who developed persistent altered consciousness, seizures, and hypoxia secondary to a comminuted sacral fracture. Although the patient could not survive owing to multiple factors, imaging played a pivotal role in expediting the diagnostic process and aiding early management.
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Affiliation(s)
- Xi Yao Gui
- Department of Radiology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| | - Waqas Ahmad
- Department of Radiology, Vancouver General Hospital, Vancouver, CAN
| | - Ismail Ali
- Department of Radiology, Vancouver General Hospital, Vancouver, CAN
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2
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Xie VX, Harrar D, Murnick J, Bharucha-Goebel D, Sen K. Starfield Pattern on Brain MRI in a Patient with Duchenne Muscular Dystrophy. Neuropediatrics 2024; 55:146-147. [PMID: 37532227 DOI: 10.1055/a-2146-6989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Vivien X Xie
- Division of Neurology, Children's National Hospital, Washington, District of Columbia, United States
| | - Dana Harrar
- Division of Neurology, Children's National Hospital, Washington, District of Columbia, United States
| | - Jonathan Murnick
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, United States
| | - Diana Bharucha-Goebel
- Division of Neurology, Children's National Hospital, Washington, District of Columbia, United States
| | - Kuntal Sen
- Division of Neurodevelopmental Pediatrics and Neurogenetics, Children's National Hospital, Washington, District of Columbia, United States
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3
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Garg D, Agarwal A, Srivastava AK, Garg A. Brain imaging inspired by outer space. Pract Neurol 2023; 23:542-546. [PMID: 37419674 DOI: 10.1136/pn-2023-003787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/09/2023]
Abstract
Medicine has many vividly named signs. We have compiled a list of radiological cerebral signs inspired by phenomena in outer space. These range from the well-known 'starry sky' appearance of neurocysticercosis or tuberculomas, to various lesser known signs including the 'starfield' pattern of fat embolism; 'sunburst' sign of meningiomas; 'eclipse' sign of neurosarcoidosis; 'comet tail' sign of cerebral metastases; 'Milky Way' sign of progressive multifocal leukoencephalopathy; 'satellite' and 'black hole' sign of intracranial haemorrhage; 'crescent' sign of arterial dissection and 'crescent moon' sign of Hirayama disease.
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Affiliation(s)
- Divyani Garg
- Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Garg
- Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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Huang GS, Dunham CM, Chance EA. Occurrence of Numerous Cerebral White Matter Hyperintensities in Trauma Patients With Cerebral Fat Embolism: A Systematic Review and Report of Two Cases. Cureus 2023; 15:e45450. [PMID: 37859880 PMCID: PMC10583483 DOI: 10.7759/cureus.45450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
There has been little effort to identify an overall occurrence of numerous cerebral white matter hyperintensities (NCWMH) on relevant brain magnetic resonance imaging (MRI) sequences in postinjury cerebral fat embolism syndrome (CFES) patients. Also, quantification of pre-CFES cognitive status, degree of neurologic deterioration, and presence of a skeletal fracture with CFES is nominal. The authors performed a PubMed search and identified 24 relevant manuscripts. Two case reports from the authors' institution were also used. The presence of NCWMH was assessed by reviewing T2-weighted image (T2WI), diffusion-weighted image (DWI), fluid-attenuated inversion recovery (FLAIR) figures and captions, and by evaluating manuscript descriptions. When pre-CFES cognitive status was described, it was categorized as Glasgow Coma Scale (GCS) score = 14-15 (yes or no). When the degree of neurologic deterioration was noted with CFES, it was classified as coma or GCS ≤ 8 (yes or no). When skeletal fractures were itemized, they were categorized as yes or no. The total number of CFES patients was 133 (literature search was 131 and two author-described case reports). Of the 131 patients with manuscript MRI figures or descriptive statements, 120 (91. 6%) had NCWMH. Of 63 patients with a delineation of the MRI sequence, NCWMH appeared on DWI in 24, on T2WI in 57, and on FLAIR in 10 patients. Pre-CFES cognitive status was GCS 14-15 in 93.5% (58/62) of the patients. The CFES neurologic deterioration was coma or GCS ≤ 8 in 52.5% (62/118) of the patients. A skeletal fracture was present in 99.0% (101/102) of the CFES patients. The presence of NCWMH in trauma patients with hospital-acquired neurologic deterioration and the presence of a skeletal fracture is consistent with CFES.
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Affiliation(s)
- Gregory S Huang
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - C Michael Dunham
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - Elisha A Chance
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, Youngstown, USA
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Alzayadneh MA, Alsherbini KA. A Rare Case of Progressive Encephalopathy in a Sickle Cell Trait Patient: A Case Report. Cureus 2023; 15:e45936. [PMID: 37766778 PMCID: PMC10520993 DOI: 10.7759/cureus.45936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
Fat embolism syndrome (FES) is one of the underdiagnosed and underrecognized complications that can happen in multiple medical and surgical conditions. FES can manifest in a broad spectrum of signs and symptoms and affect multiple organ systems in the human body. One of the most commonly involved is the central nervous system (CNS), mainly the brain, which can be involved in different ways, and the presenting symptoms can vary in type and severity. One of the most common causes of FES is trauma, mainly a long bone fracture or any orthopedic injury. However, one of the rare causes of FES is sickle cell disease (SCD) and thalassemia. Generalized and vague presenting symptoms, the rarity of FES, and the absence of well-defined diagnostic criteria make it a challenging diagnosis for healthcare practitioners. FES diagnosis is usually made after having a high index of suspicion in patients with underlying risk factors that can precipitate and contribute to the pathophysiology of FES. Moreover, the diagnosis is usually reached after excluding other more common and treatable conditions.
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Affiliation(s)
| | - Khalid A Alsherbini
- Neurology/Neurocritical Care, University of Tennessee Health Science Center (UTHSC), Memphis, USA
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Mohammed-Hadj S, Colard M, Delpierre I, Taccone F, Lolli VE. Fat emboli and critical illness-associated cerebral microbleeds (CICMs) in a patient with sickle cell disease: Do these 2 entities coexist? Radiol Case Rep 2023; 18:1978-1981. [PMID: 36970237 PMCID: PMC10034566 DOI: 10.1016/j.radcr.2023.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/28/2023] Open
Abstract
We report the case of a 30-year-old female patient with sickle cell disease presenting with an acute chest syndrome and neurological deterioration. Cerebral magnetic resonance imaging revealed a handful of foci of diffusion restriction and numerous microbleeds with marked involvement of corpus callosum and subcortical white matter, with relative sparing of the cortex and deep white matter. Corpus callosum-predominant and juxtacortical microbleeds have been typically documented in cerebral fat embolism syndrome, but also in the so-called "critical-illness-associated cerebral microbleeds", a recently described entity associated with respiratory failure. We discussed whether these 2 entities may coexist.
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Affiliation(s)
- Selsabil Mohammed-Hadj
- Radiology Department, CUB-Hôpital Erasme, 808 route de Lennik, 1070 Brussels, Belgium
- Corresponding author.
| | - Martin Colard
- Onco-hematology Department, CUB-Hôpital Erasme, 808 route de Lennik, 1070 Brussels, Belgium
| | - Isabelle Delpierre
- Radiology Department, CUB-Hôpital Erasme, 808 route de Lennik, 1070 Brussels, Belgium
| | - Fabio Taccone
- Intensive care unit, CUB-Hôpital Erasme, 808 route de Lennik, 1070 Brussels, Belgium
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Kimura S, Yagi R, Kishi F, Ogawa D, Yamada K, Taniguchi H, Wanibuchi M. A Case of Fulminant Fat Embolism Syndrome With Very Early Onset After Femoral Neck and Sacral Fractures. Cureus 2023; 15:e35911. [PMID: 37033540 PMCID: PMC10081915 DOI: 10.7759/cureus.35911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Fulminant fat embolism syndrome (FES) occurring within 1 h after trauma is extremely rare. We report a case of fulminant FES that developed hyperacute nature after a traumatic injury. A 66-year-old woman was injured when she fell approximately 1.5 m down the stairs. She was rushed to our hospital. One minute after arrival, which was 49 min after the injury, her consciousness and respiratory status deteriorated. Thoracoabdominal and pelvic computed tomography revealed preexisting interstitial pneumonia, a left femoral neck fracture, and a left sacral fracture. Head magnetic resonance imaging (diffusion-weighted imaging) showed diffuse high-signal areas and susceptibility-weighted imaging showed diffuse small perivascular of perivascular hemorrhages. She was diagnosed with fulminant FES. After conservative treatment, she was transferred to a rehabilitation hospital with a Glasgow Coma Scale (GCS) of 8 and a modified Rankin Scale of 5 on Day 45. The possibility of fulminant FES should be considered a cause of early impaired consciousness after a fracture.
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Affiliation(s)
- Seigo Kimura
- Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, JPN
| | - Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Osaka, JPN
| | - Fumihisa Kishi
- Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, JPN
| | - Daiji Ogawa
- Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, JPN
| | - Keiichi Yamada
- Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, JPN
| | - Hirokatsu Taniguchi
- Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, JPN
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Osaka, JPN
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den Otter LAS, Vermin B, Goeijenbier M. Fat embolism syndrome in a patient that sustained a femoral neck fracture: A case report. Front Med (Lausanne) 2022; 9:1058824. [PMID: 36569129 PMCID: PMC9772285 DOI: 10.3389/fmed.2022.1058824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
Background We present a case of a patient with a femoral neck fracture that shows neurological impairment and respiratory distress 1 day after trauma, caused by the Fat Embolism Syndrome with the presence of Cerebral Fat Embolisms. Case summary A 75 year old female remained unresponsive after a hemi arthroplasty was performed because of a 1 day old femoral neck fracture. She rapidly developed respiratory insufficiency and an obstructive shock with right ventricle dilatation on transthoracic echocardiography. The diffusion-weighted MRI brain images showed the "Starfield" pattern, a radiologic phenomenon typical for FES. During 3 weeks of ICU admission the neurologic state slowly ameliorated. Conclusion The rare FES is a clinical diagnosis with mainly respiratory, neurologic and dermatologic symptoms in the setting of a trauma patient. Fat embolisms are able to reach the brain without the presence of a patent foramen ovale to cause neurological symptoms. Diagnosing FES remains challenging but the distinctive "Starfield" pattern on MRI scans is promising.
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Affiliation(s)
- L. A. S. den Otter
- Department of Intensive Care Medicine, Spaarne Gasthuis, Haarlem, Netherlands,*Correspondence: L. A. S. den Otter
| | - B. Vermin
- Department of Intensive Care Medicine, Spaarne Gasthuis, Haarlem, Netherlands
| | - M. Goeijenbier
- Department of Intensive Care Medicine, Spaarne Gasthuis, Haarlem, Netherlands,Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, Netherlands
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Cerebral fat embolism syndrome at a single trauma center. J Stroke Cerebrovasc Dis 2022; 31:106794. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/21/2022] Open
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Posttraumatic Headaches and Postcraniotomy Syndromes. Neurol Clin 2022; 40:609-629. [PMID: 35871787 DOI: 10.1016/j.ncl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Headaches following head trauma or craniotomy have multiple causes, each of which has characteristic imaging features. Posttraumatic headaches may relate to intracranial hemorrhage, fracture, shear injury, mass effect, or vascular injury. Various complications of craniotomy and craniectomy may manifest with headache. CT and MRI of the brain play important roles in diagnosing these causes of headache.
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Filippatou AG, Naveed M, Barry DP, Deboer SR, Haas CJ. Sickle cell disease and fat embolism: a rare complication of vaso-occlusive crisis. Pract Neurol 2022; 22:410-412. [PMID: 35450964 DOI: 10.1136/practneurol-2021-003166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/04/2022]
Abstract
A 61-year-old woman was admitted to the hospital for management of a painful vaso-occlusive crisis. She had a history of sickle cell beta-thalassaemia and end-stage renal disease managed with intermittent haemodialysis. While hospitalised, she became lethargic and unresponsive and developed acute chest syndrome. Initial MR scan of brain, cerebrospinal fluid examination and continuous electroencephalogram were unremarkable, but subsequent MR scan of brain identified a right transverse venous sinus thrombosis and extensive supratentorial and infratentorial microhaemorrhages consistent with fat emboli. We; therefore, discuss a case of non-traumatic fat embolism syndrome, a rare complication of sickle cell disease.
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Affiliation(s)
| | - Muhammad Naveed
- Department of Internal Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Daniel P Barry
- Department of Internal Medicine, MedStar Health, Baltimore, Maryland, USA
| | - Scott R Deboer
- Department of Neurology, MedStar Health, Baltimore, Maryland, USA
| | - Christopher J Haas
- Department of Internal Medicine, MedStar Health, Baltimore, Maryland, USA
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Mburu L, Du K, Mbugua S, Mavuti J, Ali SK. Cerebral Fat Embolism: A Rare East African Conundrum. Cureus 2022; 14:e23940. [PMID: 35547438 PMCID: PMC9085708 DOI: 10.7759/cureus.23940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Cerebral fat embolism (CFE) is a potentially fatal condition associated with displaced long bone fracture of the lower extremities. CFE, usually seen in young men, has an incidence ranging between 0.9% and 11% in patients with long bone fractures. CFE can present with various neurological symptoms, and a diffusion-weighted magnetic resonance imaging (MRI) (DWI) remains the definitive diagnostic study. Early treatment of the fracture is crucial in the management of CFE. To the best of our knowledge, we are the first to report a case of CFE in East Africa.
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Armstrong BRW, Devendra A, Pokale S, Subramani B, Rajesh Babu V, Ramesh P, Dheenadhayalan J, Rajasekaran S. Can the rate of mortality and neurological recovery be predicted from the time of onset of symptoms and MRI grade in patients with cerebral fat embolism? : a study of 34 patients. Bone Joint J 2022; 104-B:142-149. [PMID: 34969291 DOI: 10.1302/0301-620x.104b1.bjj-2021-0420.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess whether it is possible to predict the mortality, and the extent and time of neurological recovery from the time of the onset of symptoms and MRI grade, in patients with the cerebral fat embolism syndrome (CFES). This has not previously been investigated. METHODS The study included 34 patients who were diagnosed with CFES following trauma between 2012 and 2018. The clinical diagnosis was confirmed and the severity graded by MRI. We investigated the rate of mortality, the time and extent of neurological recovery, the time between the injury and the onset of symptoms, the clinical severity of the condition, and the MRI grade. All patients were male with a mean age of 29.7 years (18 to 70). The mean follow-up was 4.15 years (2 to 8), with neurological recovery being assessed by the Glasgow Outcome Scale and the Mini-Mental State Examination. RESULTS In all, seven who had early-onset CFES (< 24 hours), and a severe Takahashi grade on MRI, died. There was a significant association between the time of onset of neurological signs and mortality (p = 0.035). Mortality was also significantly associated with a severe Takahashi grade (p < 0.001). Among the 27 surviving patients, 26 (96.3%) recovered completely. One (3.7%) had a cognitive deficit. The mean time to recovery was 4.7 weeks (2 to 13), with late recovery aftereight eight weeks being recorded in three patients. CONCLUSION There was a significantly increased rate of mortality in patients with CFES who had an early onset of symptoms and a severe grade on MRI. Complete neurological recovery can be expected in most patients with CFES who survive. Cite this article: Bone Joint J 2022;104-B(1):142-149.
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Affiliation(s)
- B Roy W Armstrong
- Department of Orthopaedics and Trauma Surgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - Agraharam Devendra
- Department of Orthopaedics and Trauma Surgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - Shweta Pokale
- Department of Orthopaedics and Trauma Surgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - Bala Subramani
- Department of Orthopaedics and Trauma Surgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - Velmurugan Rajesh Babu
- Department of Orthopaedics and Trauma Surgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - Perumal Ramesh
- Department of Orthopaedics and Trauma Surgery, Ganga Medical Centre and Hospital, Coimbatore, India
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Hsu TL, Li TC, Lai FP, Ouhyoung M, Chang CH, Wang CT. Late-onset isolated cerebral fat embolism syndrome after a simple tibial plateau fracture: a rare case report. J Int Med Res 2021; 49:3000605211028415. [PMID: 34282643 PMCID: PMC8295961 DOI: 10.1177/03000605211028415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
Fat embolism syndrome (FES) is a complication of long bone fractures that often occurs within 72 hours of injury. Early-onset isolated cerebral fat embolism is catastrophic and rarely reported. We herein present a rare case of delayed-onset isolated cerebral FES that developed 10 days after definite fixation of a left tibial plateau fracture. A 70-year-old woman was injured in a traffic accident and diagnosed with a left tibial plateau fracture. However, she developed sudden loss of consciousness (E4V1M1) and quadriplegia 10 days after fracture fixation. Her vital signs showed no respiratory distress. Diagnosis of isolated cerebral FES was made based on magnetic resonance imaging of the brain, the findings of which were compatible with the clinical neurological findings. After supportive care and rehabilitation, her consciousness became clear on the second day of admission, and her consciousness changed to E4V5M6. She gradually regained strength in her right limbs but had residual left limb paraplegia. Isolated cerebral FES should always be considered for patients who develop a change in consciousness, even beyond 72 hours after injury. Imaging may not initially show definitive abnormalities. Repeated magnetic resonance imaging should be considered if the initial clinical presentation does not fully meet Gurd's criteria.
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Affiliation(s)
- Ta-Li Hsu
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City
| | - Tien-Chi Li
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei City
| | - Fei-Pi Lai
- Graduate Institute of Networking and Multimedia, National Taiwan University, New Taipei City
| | - Ming Ouhyoung
- Graduate Institute of Networking and Multimedia, National Taiwan University, New Taipei City
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City
| | - Cheng-Tzu Wang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City
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Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time-A Systematic Review. J Clin Med 2021; 10:jcm10122733. [PMID: 34205701 PMCID: PMC8234368 DOI: 10.3390/jcm10122733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fat embolism (FE) continues to be mentioned as a substantial complication following acute femur fractures. The aim of this systematic review was to test the hypotheses that the incidence of fat embolism syndrome (FES) has decreased since its description and that specific injury patterns predispose to its development. MATERIALS AND METHODS Data Sources: MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for articles from 1 January 1960 to 31 December 2019. STUDY SELECTION Original articles that provide information on the rate of FES, associated femoral injury patterns, and therapeutic and diagnostic recommendations were included. DATA EXTRACTION Two authors independently extracted data using a predesigned form. STATISTICS Three different periods were separated based on the diagnostic and treatment changes: Group 1: 1 January 1960-12 December 1979, Group 2: 1 January 1980-1 December 1999, and Group 3: 1 January 2000-31 December 2019, chi-square test, χ2 test for group comparisons of categorical variables, p-value < 0.05. RESULTS Fifteen articles were included (n = 3095 patients). The incidence of FES decreased over time (Group 1: 7.9%, Group 2: 4.8%, and Group 3: 1.7% (p < 0.001)). FES rate according to injury pattern: unilateral high-energy fractures (2.9%) had a significantly lower FES rate than pathological fractures (3.3%) and bilateral high-energy fractures (4.6%) (p < 0.001). CONCLUSIONS There has been a significant decrease in the incidence of FES over time. The injury pattern impacts the frequency of FES. The diagnostic and therapeutic approach to FES remains highly heterogenic to this day.
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Giyab O, Balogh B, Bogner P, Gergely O, Tóth A. Microbleeds show a characteristic distribution in cerebral fat embolism. Insights Imaging 2021; 12:42. [PMID: 33788069 PMCID: PMC8010501 DOI: 10.1186/s13244-021-00988-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/19/2021] [Indexed: 11/19/2022] Open
Abstract
This systematic review aims to test the hypothesis that microbleeds detected by MRI are common and show a characteristic pattern in cerebral fat embolism (CFE). Eighty-four papers involving 140 CFE patients were eligible for this review based on a systematic literature search up to 31 January 2020. An additional case was added from hospital records. Patient data were individually scrutinised to extract epidemiological, clinical and imaging variables. Characteristic CFE microbleed pattern resembling a "walnut kernel" was defined as punctuate hypointensities of monotonous size, diffusely located in the subcortical white matter, the internal capsule and the corpus callosum, with mostly spared corona radiata and non-subcortical centrum semiovale, detected by susceptibility- or T2* weighted imaging. The presence rate of this pattern and other, previously described MRI markers of CFE such as the starfield pattern and further diffusion abnormalities were recorded and statistically compared. The presence rate of microbleeds of any pattern, the "walnut kernel microbleed pattern", diffusion abnormality of any pattern, the starfield pattern, and cytotoxic edema in the corpus callosum was found to be 98.11%, 89.74%, 97.64%, 68.5%, and 77.27% respectively. The presence rate between the walnut kernel and the starfield pattern was significantly (p < 0.05) different. Microbleeds are common and mostly occur in a characteristic pattern resembling a "walnut kernel" in the CFE MRI literature. Microbleeds of this pattern in SWI or T2* MRI, along with the starfield pattern in diffusion imaging appear to be the most important imaging markers of CFE and may aid the diagnosis in clinically equivocal cases.
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Affiliation(s)
- Omar Giyab
- Department of Medical Imaging, University of Pécs Medical School, Ifjúság út 13, 7624, Pécs, Hungary.
| | - Bendegúz Balogh
- Department of Medical Imaging, University of Pécs Medical School, Ifjúság út 13, 7624, Pécs, Hungary
| | - Péter Bogner
- Department of Medical Imaging, University of Pécs Medical School, Ifjúság út 13, 7624, Pécs, Hungary
| | - Orsi Gergely
- Department of Medical Imaging, University of Pécs Medical School, Ifjúság út 13, 7624, Pécs, Hungary
- Department of Neurosurgery, University of Pécs Medical School, Rét utca 2, Pécs, 7623, Hungary
- MTA-PTE Clinical Neuroscience MR Research Group, University of Pécs Medical School, Ifjuság út 20, Pécs, 7624, Hungary
| | - Arnold Tóth
- Department of Medical Imaging, University of Pécs Medical School, Ifjúság út 13, 7624, Pécs, Hungary
- MTA-PTE Clinical Neuroscience MR Research Group, University of Pécs Medical School, Ifjuság út 20, Pécs, 7624, Hungary
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Fowler JB, Fiani B, Sarhadi K, Cortez V. Cerebral fat embolism in the absence of a long bone fracture: A rare case report. Surg Neurol Int 2021; 12:78. [PMID: 33767882 PMCID: PMC7982099 DOI: 10.25259/sni_946_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/10/2021] [Indexed: 11/04/2022] Open
Abstract
Background The classic triad of fat embolism syndrome consists of pulmonary distress, mental status change, and petechial rash. Typically, symptoms manifest 24-48 hours after a long bone fracture, but case reports have demonstrated fat embolism syndrome without long bone fracture. These cases are initiated by a stress response, mobilizing free fatty acids into the circulation. Case Description Herein, we present the case of a 70-year-old male who presented with the left-sided hemiparesis and was subsequently found to have tandem lesions of the right internal carotid artery (ICA) and right middle cerebral artery (MCA) warranting emergent mechanical thrombectomy (MT). The ensuing pathology report determined the source of ischemic stroke to be caused by fat embolism, a rare and intriguing case of cryptogenic large vessel occlusion (LVO) with unique features distinguishing it from other reports in the literature. Conclusion According to the biochemical theory, a catecholamine surge can precipitate fat globules forming in the circulatory system, leading to tissue hypoxia, injury, and ischemia. While the majority of cerebral fat emboli cause reversible ischemia of small diameter vessels, our case presents with LVO and tandem lesions in both the ICA and MCA resulting in infarct and residual hemiparesis.
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Affiliation(s)
- James B Fowler
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
| | - Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States
| | - Kasra Sarhadi
- Department of Neurology, University of Washington, Seattle, Washington, United States
| | - Vladimir Cortez
- Department of Neurosurgery, Redlands Community Hospital, Redlands, California, United States
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Mirza K, Acharya PU, Austine J. Transient cortical blindness in fat embolism syndrome---a diagnostic enigma. Chin J Traumatol 2021; 24:79-82. [PMID: 33627294 PMCID: PMC8071712 DOI: 10.1016/j.cjtee.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 02/04/2023] Open
Abstract
Fat embolism syndrome (FES) is a serious life-threatening manifestation of the fat embolism phenomenon characterized by Bergman's triad of dyspnea, petechiae and mental confusion. While fat embolization into systemic circulation is common, FES occurs in a meagre 0.05%-3% of patients having isolated long bone fractures. Though visual symptoms are commonly attributed to fat embolism retinopathy and is a later occurrence, it may not always be the case. Cortical blindness has been seldom reported in association with FES, and less so as a presenting complaint. Furthermore, no previous literature has described the same in context of an isolated tibia fracture. We report a 20-year-old gentleman with an isolated right tibia shaft fracture who developed sudden onset diminution of vision in both eyes less than 24 h following trauma with no other complaints. Lack of any remarkable ophthalmoscopic findings or other symptoms left us with a diagnostic conundrum. He later went on to develop altered mentation, hypoxia and generalized tonic-clonic seizures with subsequent MRI revealing multiple cerebral fat emboli also involving both occipital lobes. Supportive measures were instituted and his general condition as well as vision gradually improved following which he underwent plate fixation of the fracture under spinal anaesthesia. The perioperative period was uneventful and he was discharged following staple removal. At one month of follow-up, the patient had no residual visual field defects or neurological deficits. Though FES is rare among isolated tibia fractures, this clinical catastrophe may strike in any unsuspected setting thereby warranting a high index of suspicion to ensure early diagnosis and improved patient outcomes.
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Affiliation(s)
- Kiyana Mirza
- Department of Orthopaedic Surgery, Father Muller Medical College Hospital, Mangalore, 575002, India,Corresponding author.
| | - Prashant Upendra Acharya
- Department of Orthopaedic Surgery, Father Muller Medical College Hospital, Mangalore, 575002, India
| | - Jose Austine
- Department of Orthopaedic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India
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Li M, Zhu G, Guo H, Ge SN, Gao GD, Qu Y. Cerebral fat embolization with paroxysmal sympathetic hyperactivity syndrome and septic shock at high altitude: a case report and literature review. Chin Neurosurg J 2021; 7:18. [PMID: 33597027 PMCID: PMC7890899 DOI: 10.1186/s41016-021-00232-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/04/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Cerebral fat embolism (CFE) syndrome at high altitude was rare complicated with paroxysmal sympathetic hyperactivity (PSH) syndrome and septic shock. It is a challenge to differential diagnosis and treatment at high altitude. CASE PRESENTATION This case presents a CFE with PSH and septic shock of a 23-year-old man occurred at high altitude of 3800 m above sea level, transferred by airplane successfully and cured in the department of neurosurgery, Xi'an Tangdu Hospital. CONCLUSIONS It is key that CFE with PSH can be rapid diagnosed and treatment bundles of septic shock should be initiated as soon as possible. Early neurological rehabilitation played an important role for good outcome.
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Affiliation(s)
- Min Li
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, China
| | - Gang Zhu
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, China
| | - Hao Guo
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, China
| | - Shun Nan Ge
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, China
| | - Guo Dong Gao
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, China
| | - Yan Qu
- Department of Neurosurgery, The Second Affiliated Hospital, Air Force Medical University, No. 569 Xinsi Road, Xi'an, 710038, China.
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20
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Wang W, Chen W, Zhang Y, Su Y, Wang Y. Post-traumatic cerebral fat embolism syndrome with a favourable outcome: a case report. BMC Neurol 2021; 21:82. [PMID: 33602171 PMCID: PMC7890386 DOI: 10.1186/s12883-021-02076-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background Fat embolism syndrome (FES) is a change in physiology resulting from mechanical causes, trauma, or sepsis. Neurological manifestations of FES can vary from mild cognitive changes to coma and even cerebral oedema and brain death. Here, we present an unusual case of cerebral fat emboli that occurred in the absence of acute chest syndrome or right-to-left shunt. Case presentation A previously healthy 57-year-old right-handed male was admitted to our department because of unconsciousness after a car accident for 3 days. He suffered from multiple fractures of the bilateral lower extremities and pelvis. This patient had severe anaemia and thrombocytopenia. Head MRI showed multiple small lesions in the whole brain consistent with a “star field” pattern, including high signals on T2-weighted (T2w) and fluid-attenuated inversion recovery (FLAIR) images in the bilateral centrum semiovale; both frontal, parietal and occipital lobes; and brainstem, cerebellar hemisphere, and deep and subcortical white matter. Intravenous methylprednisolone, heparin, mannitol, antibiotics and nutritional support were used. Although this patient had severe symptoms at first, the outcome was favourable. Conclusions When patients have long bone and pelvic fractures, multiple bone fractures and deteriorated neurological status, cerebral fat embolism (CFE) should be considered. Additionally, CFE may occur without an intracardiac shunt. The early diagnosis and appropriate management of FES are important, and prior to and following surgery, patients should be monitored comprehensively in the intensive care unit. With appropriate treatment, CFE patients may achieve good results.
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Affiliation(s)
- Wei Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th Changchun Street, 100053, Beijing, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th Changchun Street, 100053, Beijing, China
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th Changchun Street, 100053, Beijing, China.
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th Changchun Street, 100053, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 45th Changchun Street, 100053, Beijing, China
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21
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Affiliation(s)
- María Lucía Brun-Vergara
- From the Department of Diagnostic Radiology, Fundación Santa Fe de Bogotá, Cra 116 #9-02, Bogotá, Colombia 110111 (M.L.B.V.); and R.H. Ackerman Neurovascular Lab, Massachusetts General Hospital, Boston, Mass (D.M.)
| | - Daniel Montes
- From the Department of Diagnostic Radiology, Fundación Santa Fe de Bogotá, Cra 116 #9-02, Bogotá, Colombia 110111 (M.L.B.V.); and R.H. Ackerman Neurovascular Lab, Massachusetts General Hospital, Boston, Mass (D.M.)
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22
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Wang Y, Si Z, Han J, Cao S. Imaging findings of cerebral fat embolism syndrome: a case report. J Int Med Res 2020; 48:300060520950559. [PMID: 32910696 PMCID: PMC7488909 DOI: 10.1177/0300060520950559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Cerebral fat embolism (CFE) syndrome is relatively rare in clinical practice. Currently, there is no uniform standard of magnetic resonance imaging for the diagnosis of the disease. In this report, we present head computed tomography and magnetic resonance images (T2-weighted images, fluid-attenuated inversion recovery images, diffusion-weighted images, and susceptibility-weighted images) in a case of CFE. This report explains the imaging characteristics of CFE and improves the clinician’s understanding of this disease and its etiology.
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Affiliation(s)
- Yali Wang
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Zhihua Si
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Jingzhe Han
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Shuangqing Cao
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
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23
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Lee HS, Park JJ, Roh HG, Lim SD. Unusual clinicopathological presentation of nontraumatic cerebral fat embolism: Two-case report. Medicine (Baltimore) 2020; 99:e19574. [PMID: 32195967 PMCID: PMC7220548 DOI: 10.1097/md.0000000000019574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE Fat embolism syndrome (FES) is characterized by the classical triad of cerebral, respiratory, and cutaneous manifestations. In contrast, cerebral fat embolism (CFE), corresponding to incomplete pure type FES, is much rarer and usually follows trauma. CFE typically shows a "starfield" pattern on diffusion-weighted magnetic resonance imaging due to the involvement of multiple small arteries. We report 2 unusual cases of CFE that showed a nontraumatic etiology and the involvement of a single dominant cerebral artery. PATIENT CONCERNS Case 1 was a 33-year-old woman without a history of trauma who visited the emergency room due to hemiparesis and hemisensory deficits. She was a heavy smoker and had used oral contraceptives for several years. Most importantly, she had 2 experiences of autologous fat grafting 2 months previously. Magnetic resonance angiography (MRA) revealed acute occlusion of the right middle cerebral artery. Case 2 was an 80-year-old man suddenly presented with dizziness, ataxia, and left-sided sensorimotor dysfunction. He had a history of hypertension, untreated atrial fibrillation, and chronic alcoholism. MRA demonstrated the occlusion of the distal basilar artery. DIAGNOSIS Case 1: Microscopic findings demonstrated variable sized fat vacuoles intermixed with moderate amounts of thrombi. Case 2: Histologically, mature adipocytes were intermingled with fibrin, blood cells, and a fragment of entrapped soft tissue resembling the vessel wall. INTERVENTION Case 1 and 2 underwent aspirational thrombectomy guided by transfemoral cerebral angiography. OUTCOME Case 1 recovered well but Case 2 still suffers from gait ataxia. LESSONS CFE can rarely occur in various nontraumatic conditions, with or without evident etiology. Furthermore, it may not show characteristic clinicopathological manifestations. Therefore, careful follow up of those who have undergone procedures that are likely to trigger FES or who have hemodynamic or hypercoagulable risk factors is needed.
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Affiliation(s)
- Hye Seung Lee
- Department of Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea
- Department of Pathology, Korea Clinical Laboratory, Seoul, Republic of Korea
| | | | - Hong Gee Roh
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - So Dug Lim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Republic of Korea
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24
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Traumatic Neuroemergency: Imaging Patients with Traumatic Brain Injury—An Introduction. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-38490-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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25
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Saran JS, Hussain AH, Papadakos PJ, Roberts D. Cerebral Fat Embolism Syndrome. J Emerg Med 2020; 58:e95-e96. [PMID: 31818610 DOI: 10.1016/j.jemermed.2019.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Jagroop S Saran
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ali H Hussain
- Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter J Papadakos
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Debra Roberts
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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26
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Gil-Perotin S, Carreres-Polo J. Usefulness of susceptibility-weighted imaging in subacute cerebral fat embolism. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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27
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Godoy DA, Di Napoli M, Rabinstein AA. Cerebral Fat Embolism: Recognition, Complications, and Prognosis. Neurocrit Care 2019; 29:358-365. [PMID: 28932982 DOI: 10.1007/s12028-017-0463-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fat embolism syndrome (FES) is a rare syndrome caused by embolization of fat particles into multiple organs including the brain. It typically manifests with petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24-48 h of trauma with long-bone fractures or an orthopedic surgery. The diagnosis of FES is based on clinical and imaging findings, but requires exclusion of alternative diagnoses. Although there is no specific treatment for FES, prompt recognition is important because it can avoid unnecessary interventions and clarify prognosis. Patients with severe FES can become critically ill, but even comatose patients with respiratory failure may recover favorably. Prophylactic measures, such as early stabilization of fractures and certain intraoperative techniques, may help decrease the incidence and severity of FES.
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Affiliation(s)
- Daniel Agustín Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Chacabuco 675, 4700, Catamarca, Argentina.
- Intensive Care Unit, Hospital San Juan Bautista, Catamarca, Argentina.
| | - Mario Di Napoli
- Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy
- Neurological Section, SMDN-Center for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy
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28
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Huq SMR, Anam AM, Joarder N, Islam MM, Rabbani R, Shaikh AK. A young adult with
post-traumatic breathlessness, unconsciousness and rash. Breathe (Sheff) 2019; 15:e126-e130. [PMID: 31777576 PMCID: PMC6876139 DOI: 10.1183/20734735.0212-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 23-year-old Bangladeshi male was referred to our hospital for gradual worsening of breathlessness over 3 h, developed following a road-accident about 14 h previously. He had a close fracture of mid-shaft of his right tibia, which was immobilised with back slab at the previous healthcare facility. During presentation at the emergency department, he was conscious and oriented (Glasgow coma scale 15/15), tachycardic (heart rate 132 per min), blood pressure 100/70 mmHg, tachypnoeic (respiratory rate 34 per min) with oxygen saturation 89% on room air, and afebrile. Chest examination revealed restricted chest movement, hyper-resonant percussion notes and reduced breath sound on the left, and diffuse crackles on both sides. Can you diagnose this young adult with post-traumatic breathlessness, unconsciousness and rash?http://bit.ly/2LlpkiV
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Affiliation(s)
| | | | - Nayeema Joarder
- Intensive Care Unit, Square Hospitals Ltd., Dhaka, Bangladesh
| | | | - Raihan Rabbani
- Critical Care and Internal Medicine, Square Hospitals Ltd., Dhaka, Bangladesh
| | - Abdul Kader Shaikh
- Dept of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.,Dept of Neurology, Square Hospitals Ltd., Dhaka, Bangladesh
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29
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Li T, Feng ZQ, Qu M, Yan K, Yuan T, Gao B, Wang T, Dong W, Zheng J. Core/Shell Piezoelectric Nanofibers with Spatial Self-Orientated β-Phase Nanocrystals for Real-Time Micropressure Monitoring of Cardiovascular Walls. ACS NANO 2019; 13:10062-10073. [PMID: 31469542 DOI: 10.1021/acsnano.9b02483] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Implantable pressure biosensors show great potential for assessment and diagnostics of pressure-related diseases. Here, we present a structural design strategy to fabricate core/shell polyvinylidene difluoride (PVDF)/hydroxylamine hydrochloride (HHE) organic piezoelectric nanofibers (OPNs) with well-controlled and self-orientated nanocrystals in the spatial uniaxial orientation (SUO) of β-phase-rich fibers, which significantly enhance piezoelectric performance, fatigue resistance, stability, and biocompatibility. Then PVDF/HHE OPNs soft sensors are developed and used to monitor subtle pressure changes in vivo. Upon implanting into pig, PVDF/HHE OPNs sensors demonstrate their ultrahigh detecting sensitivity and accuracy to capture micropressure changes at the outside of cardiovascular walls, and output piezoelectric signals can real-time and synchronously reflect and distinguish changes of cardiovascular elasticity and occurrence of atrioventricular heart-block and formation of thrombus. Such biological information can provide a diagnostic basis for early assessment and diagnosis of thrombosis and atherosclerosis, especially for postoperative recrudescence of thrombus deep within the human body.
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Affiliation(s)
- Tong Li
- School of Chemical Engineering , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Zhang-Qi Feng
- School of Chemical Engineering , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Minghe Qu
- School of Chemical Engineering , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Ke Yan
- School of Chemical Engineering , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Tao Yuan
- Department of Orthopedic , Nanjing Jinling Hospital , Nanjing 210002 , China
| | - Bingbing Gao
- State Key Laboratory of Bioelectronics , Southeast University , Nanjing 210096 , China
| | - Ting Wang
- State Key Laboratory of Bioelectronics , Southeast University , Nanjing 210096 , China
| | - Wei Dong
- School of Chemical Engineering , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Jie Zheng
- Department of Chemical and Biomolecular Engineering , The University of Akron , Akron , Ohio 44325 , United States
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30
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Huang CK, Huang CY, Li CL, Yang JM, Wu CH, Chen CH, Wu PT. Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare case. BMC Musculoskelet Disord 2019; 20:377. [PMID: 31421672 PMCID: PMC6698337 DOI: 10.1186/s12891-019-2736-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 07/23/2019] [Indexed: 02/08/2023] Open
Abstract
Background Fat embolism syndrome (FES) is a rare complication that can occur between 12 and 72 h after the initial insult. Isolated cerebral FES without pulmonary symptoms is rarer. Early fracture fixation might prevent FES. We report a case of multiple-fracture with FES despite definite fixation three hours post-injury. Case presentation A 54-year-old man presented with multiple fractures: left femoral shaft (AO B2), left distal radius (AO C3), left comminuted patella, right comminuted 1st metatarsal base and left 2nd-4th metatarsal neck. Because he was stable, we gave him early total care and definite fixation, which required seven hours and yielded no complications. After he recovered from anesthesia, however, his eyes deviated right, his right upper arm was paralyzed, his consciousness level was poor, and his Glasgow Coma Scale score was E3VeM4. Chest X-rays showed clear lung fields, and brain computed tomography showed no intracranial hemorrhage. He did, however, have tachycardia, anemia, and thrombocytopenia. Brain magnetic resonance images showed a hyperintensive starfield pattern on diffuse weighted images, which suggested cerebral FES. After supportive care, his consciousness cleared on postoperative day 17, and he recovered full right upper arm muscle power after four months; however, he had a significant cognitive deficit. One-year post-injury, after regular rehabilitation therapy, he was able to independently perform his activities of daily living but still had a residual mild cognitive deficit. Conclusion Early fixation can attenuate but not eliminate the incidence of FES. Early assessment and rehabilitation therapy might be required for patients with cerebral FES and cognitive deficits; however, such deficits are difficult to predict and need long-term follow-ups.
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Affiliation(s)
- Chin-Kai Huang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Yuan Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Traumatology, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Lung Li
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Traumatology, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Ming Yang
- Department of Orthopedics, Tainan ShinLau Christian Hospital, Tainan, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Hsien Wu
- Department of Orthopedics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chih-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, 1650, Boulevard Sect. 4, Taichung, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Po-Ting Wu
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Division of Traumatology, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan. .,Department of Orthopedics, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, Taiwan. .,Department of Orthopedics, National Cheng Kung University Hospital Dou-Liou branch, College of Medicine, National Cheng Kung University, YunLin, Taiwan.
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31
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Van den Brande FGJ, Hellemans S, De Schepper A, De Paep R, Op De Beeck B, De Raeve HR, Jorens PG. Post-traumatic Severe Fat Embolism Syndrome with Uncommon CT Findings. Anaesth Intensive Care 2019; 34:102-6. [PMID: 16494160 DOI: 10.1177/0310057x0603400120] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the diagnosis of fat embolism syndrome is usually based on clinical findings, we describe ill-defined centrilobular and subpleural nodules in addition to ground-glass opacities and consolidation on a computed tomography scan of the chest in a trauma patient with fat embolism syndrome. The nodules presumably represent alveolar oedema, microhaemorrhage and an inflammatory response secondary to ischaemia and cytotoxic emboli in fat embolism syndrome. The literature of computed tomography findings in patients with fat embolism syndrome is reviewed and summarized.
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Affiliation(s)
- F G J Van den Brande
- Department of Intensive Care Medicine, University Hospital of Antwerp, Antwerp, Belgium
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32
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Huo X, Liu R, Wang Y, Sun J, Lin M, Han J, Han J, Miao Z. Cerebral Fat Embolism as Complication of Facial Fat Graft: Retrospective Analysis of Clinical Characteristics, Treatment, and Prognosis. World Neurosurg 2018; 120:249-255. [DOI: 10.1016/j.wneu.2018.08.148] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 11/26/2022]
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33
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Singh DR, Chawla A, Peh WC. Clinics in diagnostic imaging (184). Fat embolism syndrome (FES). Singapore Med J 2018; 59:159-162. [PMID: 29568848 DOI: 10.11622/smedj.2018029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 23-year-old Indian man presented with shortness of breath and new-onset confusion along with a rash on his chest on Postoperative Day 2, following internal fixation of his femur fracture. Although computed tomography pulmonary angiography was negative for filling defects in the pulmonary vasculature, it showed mosaic attenuation changes with some interlobular septal thickening. Magnetic resonance imaging of the brain showed patchy signal abnormalities, predominantly in the grey-white matter junction region with extensive susceptibility artefacts, consistent with petechial haemorrhages. The laboratory work-up showed thrombocytopenia and anaemia. A diagnosis of fat embolism syndrome was established, based on the clinical presentation combined with laboratory and imaging findings. The clinical and imaging features of fat embolism syndrome are discussed.
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Affiliation(s)
- Dinesh R Singh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Ashish Chawla
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Wilfred Cg Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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Hermann B, Brisson H, Langeron O, Pyatigorskaya N, Paquereau J, Robert H, Stender J, Habert MO, Naccache L, Monsel A. Unexpected good outcome in severe cerebral fat embolism syndrome. Ann Clin Transl Neurol 2018; 5:988-995. [PMID: 30128324 PMCID: PMC6093841 DOI: 10.1002/acn3.596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/16/2022] Open
Abstract
In this case study, we report the longitudinal and multimodal follow-up of a catastrophic initial presentation of cerebral fat embolism syndrome. We show that despite the initial severity, the cognitive outcome was ultimately very good but with a highly nonlinear time-course and prolonged loss of consciousness (more than 2 months). Repeated clinical assessments and brain-imaging techniques (electroencephalography, event-related potential, 18-Fluoro-Deoxy-Glucose-PET and magnetic resonance imaging) allowed us to monitor and anticipate this dynamic, providing relevant information to guide decision making in front of withdrawal of life-sustaining therapy discussions. This case illustrates the value of multimodal functional imaging in devastating brain injuries.
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Affiliation(s)
- Bertrand Hermann
- Department of Neurology Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France.,Inserm U 1127 Paris, France, Brain & Spine Institute ICM Paris France.,Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France
| | - Hélène Brisson
- Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Anesthesia and Critical Care Multidisciplinary Intensive Care Unit Groupe hospitalier Pitié-Salpêtrière F-75013 AP-HP Paris France
| | - Olivier Langeron
- Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Anesthesia and Critical Care Multidisciplinary Intensive Care Unit Groupe hospitalier Pitié-Salpêtrière F-75013 AP-HP Paris France
| | - Nadya Pyatigorskaya
- Inserm U 1127 Paris, France, Brain & Spine Institute ICM Paris France.,Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Neuroradiology Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France
| | - Julie Paquereau
- Department of Physical Medicine and Rehabilitation Hôpital Raymond Poincaré AP-HP Garches France
| | - Hélène Robert
- Department of Physical Medicine and Rehabilitation Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France
| | - Johan Stender
- Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France
| | - Marie-Odile Habert
- Inserm U 1127 Paris, France, Brain & Spine Institute ICM Paris France.,Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Nuclear Medicine Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France.,Laboratoire d'Imagerie Biomédicale Sorbonne Université UPMC Univ Paris 06 CNRS INSERM F-75013 Paris France
| | - Lionel Naccache
- Inserm U 1127 Paris, France, Brain & Spine Institute ICM Paris France.,Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Neurophysiology Groupe hospitalier Pitié-Salpêtrière AP-HP Paris France
| | - Antoine Monsel
- Faculté de Médecine Sorbonne Université, Sorbonne Universités Paris France.,Department of Anesthesia and Critical Care Multidisciplinary Intensive Care Unit Groupe hospitalier Pitié-Salpêtrière F-75013 AP-HP Paris France.,Sorbonne Université INSERM UMR S 959 Immunology-Immunopathology-Immunotherapy (i3) F-75005 Paris France.,Biotherapy CIC-BTi) and Inflammation-Immunopathology-Biotherapy (DHU i2B) Hôpital Pitié-Salpêtrière AP-HP F-75651 Paris France
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35
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Kouri I, Mathews K, Joshi C. Facial Weakness and Ophthalmoplegia in a 4-Day-Old Infant. Semin Pediatr Neurol 2018; 26:63-66. [PMID: 29961523 DOI: 10.1016/j.spen.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present a neonate with neurologic deficits recognized at 4 days of age. A male infant was born at term via emergency cesarian section due to failure to progress and fetal decelerations. He underwent therapeutic hypothermia for hypoxic ischemic encephalopathy. Upon completion of rewarming, he was noted to have left facial palsy, abduction deficit on the left eye past the midline, and nystagmus involving the right eye. Brain magnetic resonance imaging showed a pontine stroke, and computed tomography angiogram revealed basilar artery thrombosis. He was treated with enoxaparin for 3 months, followed by low-dose aspirin. The mechanism of the stroke remains unclear, and there is limited evidence to guide management.
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Affiliation(s)
- Ioanna Kouri
- Department of Pediatrics and Neurology, University of Iowa Stead Family Children's Hospital, Iowa City, IA.
| | - Katherine Mathews
- Department of Pediatrics and Neurology, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Charuta Joshi
- Department of Pediatrics and Neurology, University of Iowa Stead Family Children's Hospital, Iowa City, IA
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36
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Fat Embolism Syndrome in Duchenne Muscular Dystrophy Patients: Early Recognition and Aggressive Therapy. Case Rep Crit Care 2018; 2018:3686470. [PMID: 30009059 PMCID: PMC6008769 DOI: 10.1155/2018/3686470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 01/28/2023] Open
Abstract
We describe two pediatric patients with Duchenne muscular dystrophy that presented with acute neurologic deterioration and hypoxic respiratory failure requiring mechanical ventilation. These cases fulfill the clinical criteria for Fat Embolism Syndrome. Early recognition and aggressive supportive therapy with mechanical ventilation, right ventricular afterload reduction, and blood transfusion led to survival without any residual effects from the event. Fat Embolism Syndrome needs to be considered early in the course of patients with Duchenne muscular dystrophy who present with respiratory and neurological symptoms.
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37
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Fat Embolism Syndrome: A Case Report and Review Literature. Case Rep Med 2018; 2018:1479850. [PMID: 29853905 PMCID: PMC5949181 DOI: 10.1155/2018/1479850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/04/2018] [Indexed: 12/16/2022] Open
Abstract
Fat embolism syndrome (FES) is a life-threatening complication in patients with orthopedic trauma, especially long bone fractures. The diagnosis of fat embolism is made by clinical features alone with no specific laboratory findings. FES has no specific treatment and requires supportive care, although it can be prevented by early fixation of bone fractures. Here, we report a case of FES in a patient with right femoral neck fracture, which was diagnosed initially by Gurd's criteria and subsequently confirmed by typical appearances on magnetic resonance imaging (MRI) of the brain. The patient received supportive management and a short course of intravenous methylprednisolone.
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38
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T2*-Weighted and Diffusion Magnetic Resonance Imaging Differentiation of Cerebral Fat Embolism From Diffuse Axonal Injury. J Comput Assist Tomogr 2017; 41:877-883. [PMID: 28708729 DOI: 10.1097/rct.0000000000000635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study differentiates cerebral fat embolism (CFE) and diffuse axonal injury (DAI) on diffusion-weighted magnetic resonance imaging (DWI) and T2*-weighted magnetic resonance imaging. METHODS Consecutive CFE and DAI cases were retrospectively selected. Hemorrhages were characterized by number, size/shape, and distribution, whereas DWI lesions by pattern. The number of hemorrhages was compared using the Mann-Whitney test with adjustment for multiple comparisons, whereas DWI abnormality was compared using Fisher exact test. RESULTS Seven CFE and 20 DAI patients were included. Cerebral fat embolism had significantly more hemorrhages than DAI (mean, 670 ± 407 vs 136 ± 87; P = 0.01), particularly in the frontal (P = 0.025), parietal (P = 0.002), and occipital lobes (P = 0.01), the corpus callosum (P = 0.01), and cerebellum (P = 0.01). Cerebral fat embolism microhemorrhages were punctate/round, whereas DAI hemorrhages were small/medium sized (P < 0.001) and linear (P = 0.001). On DWI, DAI typically had few scattered abnormalities, whereas CFE had confluent abnormalities (P < 0.05). CONCLUSIONS Magnetic resonance imaging can differentiate CFE from DAI. Cerebral fat embolism demonstrates more hemorrhages. Larger or linear hemorrhages favor DAI. Diffuse confluent diffusion restriction favors CFE, whereas few scattered foci favor DAI.
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39
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Ischemic White Matter Lesions Associated With Medullary Arteries: Classification of MRI Findings Based on the Anatomic Arterial Distributions. AJR Am J Roentgenol 2017; 209:W160-W168. [DOI: 10.2214/ajr.16.17231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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40
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Shacklock E, Gemmell A, Hollister N. Neurological effects of fat embolism syndrome: A case report. J Intensive Care Soc 2017; 18:339-341. [PMID: 29123567 DOI: 10.1177/1751143717718664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fat embolism syndrome is a serious multi-system pathology which classically affects the respiratory system, neurological system and causes a petechial rash. We present the case of a 20-year-old farmer who developed fat embolism syndrome following a traumatic femoral fracture. Features developed within 24 h of injury and necessitated a prolonged stay in Intensive Care. He exhibited significant signs of cerebral fat embolism syndrome including coma and seizures but went on to make full functional recovery. Magnetic resonance imaging is the recommended imaging modality for patients with suspected cerebral fat embolism. In this case, computerised tomography was inconclusive, but magnetic resonance imaging demonstrated the "starfield pattern" of multiple high signal foci on a dark background. Supportive treatment of fat embolism syndrome is required in an appropriate setting, such as High Dependency or Intensive Care, for patients at risk of hypoxia or neurological deterioration. Despite major neurological involvement of fat embolism syndrome, full recovery is described by several cases including ours.
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Affiliation(s)
- Emma Shacklock
- Department of Anaesthetics and Intensive Care, North Devon District Hospital, Barnstaple, UK
| | - Andrew Gemmell
- Department of Radiology, North Devon District Hospital, Barnstaple, UK
| | - Nigel Hollister
- Department of Anaesthetics and Intensive Care, North Devon District Hospital, Barnstaple, UK
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41
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Scheifer C, Lionnet F, Bachmeyer C, Stankovic-Stojanovic K, Georgin-Lavialle S, Alamowitch S, Marro B, Mattioni S. Cerebral Fat Embolism in Hemoglobin SC Disease. Am J Med 2017; 130:e187-e189. [PMID: 28189467 DOI: 10.1016/j.amjmed.2017.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Carole Scheifer
- Service de Médecine Interne, Hôpital Tenon (AP-HP), Paris, France
| | - François Lionnet
- Service de Médecine Interne, Hôpital Tenon (AP-HP), Paris, France
| | - Claude Bachmeyer
- Service de Médecine Interne, Hôpital Tenon (AP-HP), Paris, France
| | | | | | - Sonia Alamowitch
- Service de Neurologie, Hôpital Saint Antoine (AP-HP), Paris, France
| | - Beatrice Marro
- Service de Radiologie, Hôpital Tenon (AP-HP), Paris, France
| | - Sarah Mattioni
- Service de Médecine Interne, Hôpital Tenon (AP-HP), Paris, France.
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42
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Gil-Perotin S, Carreres-Polo J. Usefulness of susceptibility-weighted imaging in subacute cerebral fat embolism. Neurologia 2017; 34:616-618. [PMID: 28427769 DOI: 10.1016/j.nrl.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 01/26/2017] [Accepted: 02/05/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- S Gil-Perotin
- Servicio de Neurología, Unidad de Investigación en Esclerosis Múltiple, Hospital Universitario i Politécnico La Fe, Valencia, España.
| | - J Carreres-Polo
- Área Clínica de Imagen Médica, Sección de Neurorradiología, Hospital Universitario i Politécnico La Fe, Valencia, España
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43
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Abstract
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections. Rapid identification and treatment of the underlying cause are imperative. Benzodiazepines increase the risk of delirium, and alternative agents are preferred sedatives. Pharmacologic treatment of agitated delirium can be achieved with antipsychotics. Nonconvulsive seizures and status epilepticus are not uncommon in surgical/trauma intensive care unit (ICU) patients, require electroencephalography for diagnosis, and need timely management. Spinal cord ischemia is a known complication in patients with traumatic aortic dissections or blunt aortic injury requiring surgery. Thoracic endovascular aortic repair has reduced the paralysis rate. Neuromuscular complications include nerve and plexus injuries, and ICU-acquired weakness. In polytrauma, the neurologic examination is often confounded by pain, sedation, mechanical ventilation, and distracting injuries. Regular sedation pauses for examination and maintaining a high index of suspicion for neurologic complications are warranted, particularly because early diagnosis and management can improve outcomes.
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Abstract
In this chapter we review the optimal imaging modalities for subacute and chronic stroke. We discuss the utility of computed tomography (CT) and multimodal CT imaging. Further, we analyze the importance of specific magnetic resonance imaging sequences, such as diffusion-weighted imaging for acute ischemic stroke, T2/fluid-attenuated inversion recovery for subacute and chronic stroke, and susceptibility imaging for detection of intracranial hemorrhages. Different ischemic stroke mechanisms are reviewed, and how these imaging modalities may aid in the determination of such. Further, we analyze how topographic patterns in ischemic stroke may provide important clues to the diagnosis, in addition to the temporal evolution of the stroke. Lastly, specific cerebrovascular occlusive diseases are reviewed, with emphasis on the optimal imaging modalities and their findings in each condition.
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45
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May J, Sullivan JC, LaVie D, LaVie K, Marques MB. Inside Out: Bone Marrow Necrosis and Fat Embolism Complicating Sickle-β+ Thalassemia. Am J Med 2016; 129:e321-e324. [PMID: 27296331 DOI: 10.1016/j.amjmed.2016.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jori May
- Department of Medicine at the University of Alabama at Birmingham.
| | | | - Daniel LaVie
- Department of Medicine at the University of Alabama at Birmingham
| | - Katherine LaVie
- Department of Medicine at the University of Alabama at Birmingham
| | - Marisa B Marques
- Department of Pathology at the University of Alabama at Birmingham
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46
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Chiappa V, Gonzalez RG, Manian FA, Deshpande V. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 23-2016. A 46-Year-Old Man with Somnolence after Orthopedic Surgery. N Engl J Med 2016; 375:370-8. [PMID: 27464205 DOI: 10.1056/nejmcpc1601840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Victor Chiappa
- From the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - R Gilberto Gonzalez
- From the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - Farrin A Manian
- From the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - Vikram Deshpande
- From the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Medicine (V.C., F.A.M.), Radiology (R.G.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
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47
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Kammeyer R, Devnani R, Mehta R. Cerebral fat embolism syndrome mimicking thrombotic thrombocytopenic purpura in a patient with hemoglobin SC disease. Am J Hematol 2016; 91:539-42. [PMID: 26701328 DOI: 10.1002/ajh.24286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Ryan Kammeyer
- University of Colorado School of Medicine; Aurora Colorado
| | - Rohit Devnani
- Division of Pulmonary; Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine; Indianapolis Indiana
| | - Rakesh Mehta
- Section of Hematology-Oncology; Department of Medicine; Indiana University School of Medicine; Indianapolis Indiana
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Newbigin K, Souza CA, Torres C, Marchiori E, Gupta A, Inacio J, Armstrong M, Peña E. Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings. Respir Med 2016; 113:93-100. [PMID: 26895808 DOI: 10.1016/j.rmed.2016.01.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopedic surgery, which presents predominantly with pulmonary symptoms. Modern intensive care has improved the mortality rates, however diagnosis remains difficult, relying predominantly on a combination of a classic triad of symptoms and non-specific, but characteristic radiological features. The aim of this review is to describe the main clinical and imaging aspects of FES, ranging from pathophysiology to treatment with emphasis on pulmonary involvement. METHODS We reviewed the currently published literature on the main characteristics of FES. RESULTS In a hypoxic patient with recent trauma or orthopedic surgery, the presence of diffuse, well-demarcated ground glass opacities or ill-defined centrilobular nodules on computed tomography (CT) of the chest are suggestive of FES. CONCLUSIONS Combination of the classic clinical syndrome in the appropriate clinical setting, together with the characteristic imaging findings on chest CT, can help to achieve the correct diagnosis. Management remains predominantly supportive care, and the benefit of medical therapies such as corticosteroids and heparin remains unclear.
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Affiliation(s)
| | | | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Joao Inacio
- The Ottawa Hospital, Ottawa, Ontario, Canada.
| | | | - Elena Peña
- The Ottawa Hospital, Ottawa, Ontario, Canada.
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49
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Aggarwal R, Pal S, Soni KD, Gamangatti S. Massive cerebral fat embolism leading to brain death: A rare presentation. Indian J Crit Care Med 2016; 19:687-9. [PMID: 26730124 PMCID: PMC4687182 DOI: 10.4103/0972-5229.169358] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Fat embolism syndrome (FES) typically consists of a triad of neurological, pulmonary, and cutaneous symptoms. There exist few case reports of FES involving central nervous system (CNS) only without pulmonary involvement. In most of such cases, CNS involvement is partial, and patients recover fully neurologically within days. We report a rare and unusual case of massive cerebral fat embolism that led to brain death in trauma patient.
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Affiliation(s)
- Richa Aggarwal
- Department of Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sugata Pal
- Department of Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamangatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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50
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Sethi D, Kajal S, Saxena A. Neuroimaging findings in a case of cerebral fat embolism syndrome with delayed recovery. Indian J Crit Care Med 2015; 19:674-7. [PMID: 26730120 PMCID: PMC4687178 DOI: 10.4103/0972-5229.169350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A young male with multiple lower limb fractures admitted to our Intensive Care Unit was diagnosed with cerebral fat embolism syndrome (FES) based on clinical features and initial magnetic resonance imaging (MRI) which showed multiple hyperintensities on T2-weighted imaging, involving bilateral cerebral and cerebellar hemispheres, predominantly in the watershed territory. The serial MRI done at 3 weeks showed more prominent and larger sized lesions which were in line with the patient's initial low Glasgow Coma Score and indicated severe cerebral insult. The patient responded well to supportive intensive care therapy; his neurological recovery though slow was consistent as he could return to his full functional status after 6 months. The follow-up MRI showed resolution of the most of earlier lesions. This indicates potentially good outcomes even in severe cases of cerebral FES with appropriate medical care.
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Affiliation(s)
- Divya Sethi
- From: Department of Anesthesia and Critical Care, Employees’ State Insurance Postgraduate Institute of Medical Sciences and Research, New Delhi, India
| | - Shveta Kajal
- From: Department of Anesthesia and Critical Care, Employees’ State Insurance Postgraduate Institute of Medical Sciences and Research, New Delhi, India
| | - Anupriya Saxena
- From: Department of Anesthesia and Critical Care, Employees’ State Insurance Postgraduate Institute of Medical Sciences and Research, New Delhi, India
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