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Yamafuji Y, Suga M, Fujisawa S, Oosuki G, Taira T, Takahashi R, Matsuyama S, Ishihara S. A case of fatal fulminant fat embolism syndrome saved by VA-ECMO in the acute phase of multiple trauma. Trauma Case Rep 2024; 51:101028. [PMID: 38633377 PMCID: PMC11021984 DOI: 10.1016/j.tcr.2024.101028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 04/19/2024] Open
Abstract
Fat embolism syndrome (FES) is a rare complication of long bone fractures, with fulminant FES developing within 12 h of injury and often proving fatal (Shaikh, 2009 [1]). Here, we present a case of fulminant FES in a patient who developed sudden right heart failure after undergoing external fixation of a lower leg fracture and required veno-arterial extracorporeal membrane oxygenation (VA-ECMO). A 79-year-old woman injured in a traffic accident was transferred to our emergency department. Upon arrival, her level of consciousness deteriorated, and she developed circulatory failure. We promptly performed transcatheter arterial embolization for the pelvic fracture and external fixation of the tibiofibular fracture. Within four hours of the injury, she was admitted to our intensive care unit (ICU). Two hours after ICU admission, her hemodynamic status worsened, necessitating the administration of maximum catecholamine dose. Echocardiography revealed petechial hemorrhage of the palpebral conjunctiva and enlargement of the right ventricle. Despite maximal supportive care, the patient remained cardiovascularly unstable. Therefore, VA-ECMO was initiated to stabilize her hemodynamic status. Thereafter, her hemodynamics stabilized, and ECMO support was weaned off and removed on day 3. Subsequent magnetic resonance imaging revealed evidence of cerebral fat embolism. On day 9, she underwent open reduction of the left lower leg with internal fixation and was transferred to another hospital on day 29. This report documents the successful management of fulminant FES during the acute phase of multiple traumas. Clinicians should consider VA-ECMO when suspecting uncontrolled circulatory failure due to fulminant FES, even in the acute phase of multiple trauma.
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Affiliation(s)
- Yuki Yamafuji
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Masafumi Suga
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Seiya Fujisawa
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Gentoku Oosuki
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Takuya Taira
- Faculty of Medicine, Graduate School of Medicine, Kagawa University, Kagawa, Japan
| | - Ryo Takahashi
- Nara Prefecture General Medical Center, Department of Intensive Care Unit, Japan
| | - Shigenari Matsuyama
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Satoshi Ishihara
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
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Bentaleb M, Abdulrahman M, Ribeiro-Junior MAF. Fat embolism: the hidden murder for trauma patients! Rev Col Bras Cir 2024; 51:e20243690. [PMID: 38716918 PMCID: PMC11185067 DOI: 10.1590/0100-6991e-20243690-en] [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] [Received: 11/16/2023] [Accepted: 03/08/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations. METHODS we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma. RESULTS the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community. CONCLUSION to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.
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Affiliation(s)
- Malak Bentaleb
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
| | - Mohammed Abdulrahman
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
| | - Marcelo Augusto Fontenelle Ribeiro-Junior
- - College of Medicine and Health Sciences, Khalifa University, Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
- - Sheikh Shakhbout Medical City, Division of Trauma, Critical Care and Acute Care Surgery - Department of Surgery - Abu Dhabi - Abu Dhabi - Emirados Árabes Unidos
- - PUC-Sorocaba, Disciplina de Cirurgia Geral e do Trauma - Sorocaba - SP - Brasil
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3
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Nielsen LF, Pott F, Lohse A, Talibi MN, Olsen MH. Cerebral fat emboli in a patient with paraplegia caused by bilateral femur fractures. BMJ Case Rep 2024; 17:e257702. [PMID: 38176747 PMCID: PMC10773286 DOI: 10.1136/bcr-2023-257702] [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] [Indexed: 01/06/2024] Open
Abstract
Cerebral fat embolism is a rare cause of stroke and therefore an overlooked diagnosis. Often it is seen as a consequence of major bone fractures or after arthroplasty, and can lead to respiratory or circulatory collapse. We present a case of a patient with a history of paraplegia after a thoracic spinal cord injury that developed cerebral fat embolism following a bilateral femur fracture. Since the patient was paraplegic and with an altered mental state upon admission, femoral bone fractures were not initially suspected. The case shows the difficulties in diagnosing this condition.
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Affiliation(s)
| | - Frank Pott
- Department of Anaesthesiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Allan Lohse
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Markus Harboe Olsen
- Department of Anaesthesiology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen, Denmark
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4
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Specht S, Zhukova I, Westhoff JH, Erb L, Ziegler A, Kölker S, Hoffmann GF, Hagmann S, Syrbe S. Fat embolism syndrome in Duchenne muscular dystrophy: Report on a novel case and systematic literature review. Eur J Paediatr Neurol 2024; 48:91-100. [PMID: 38096597 DOI: 10.1016/j.ejpn.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 03/23/2024]
Abstract
We report a non-ambulatory 13-year-old boy with Duchenne muscular dystrophy who experienced severe acute respiratory distress syndrome and cerebral fat embolism following elective soft tissue surgery. Post-surgery radiological examination revealed bilateral femoral fractures and marked osteopenia that were believed to have caused disseminated pulmonary and cerebral fat embolism. The patient had never been on glucocorticoid treatment. Five months post-surgery, he remained in a state of minimal consciousness. A literature review was performed and eleven publications included, providing case reports of a total number of 23 patients with Duchenne muscular dystrophy with fat embolism syndrome. The most common causes were falls from the wheelchair that predominantly resulted in femoral fractures. Median age at the event was around 14 years. Seven patients succumbed to complications of fat embolism. No event was described in the context of surgery. We want to raise awareness that spontaneous unnoticed fractures may occur especially in adolescents with DMD from traumatic injury of large bones and also during elective surgery with a high risk of causing fat embolism with severe sequelae.
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Affiliation(s)
- Sabine Specht
- Division of Paediatric Neurology and Metabolic Medicine, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Irina Zhukova
- Division of Paediatric Epileptology, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens H Westhoff
- Department of Paediatrics I, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Larissa Erb
- Department of Paediatrics I, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Ziegler
- Division of Paediatric Neurology and Metabolic Medicine, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kölker
- Division of Paediatric Neurology and Metabolic Medicine, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Department of Paediatrics I, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sébastien Hagmann
- Department of Orthopaedics and Trauma Surgery, Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Syrbe
- Division of Paediatric Epileptology, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Cozza M, Amadori L, Boccardi V. Exploring cerebral amyloid angiopathy: Insights into pathogenesis, diagnosis, and treatment. J Neurol Sci 2023; 454:120866. [PMID: 37931443 DOI: 10.1016/j.jns.2023.120866] [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] [Received: 07/03/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
Cerebral Amyloid Angiopathy (CAA) is a neurological disorder characterized by the deposition of amyloid plaques in the walls of cerebral blood vessels. This condition poses significant challenges in terms of understanding its underlying mechanisms, accurate diagnosis, and effective treatment strategies. This article aims to shed light on the complexities of CAA by providing insights into its pathogenesis, diagnosis, and treatment options. The pathogenesis of CAA involves the accumulation of amyloid beta (Aβ) peptides in cerebral vessels, leading to vessel damage, impaired blood flow, and subsequent cognitive decline. Various genetic and environmental factors contribute to the development and progression of CAA, and understanding these factors is crucial for targeted interventions. Accurate diagnosis of CAA often requires advanced imaging techniques, such as magnetic resonance imaging (MRI) or positron emission tomography (PET) scans, to detect characteristic amyloid deposits in the brain. Early and accurate diagnosis enables appropriate management and intervention strategies. Treatment of CAA focuses on preventing further deposition of amyloid plaques, managing associated symptoms, and reducing the risk of complications such as cerebral hemorrhage. Currently, there are no disease-modifying therapies specifically approved for CAA. However, several experimental treatments targeting Aβ clearance and anti-inflammatory approaches are being investigated in clinical trials, offering hope for future therapeutic advancements.
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Affiliation(s)
| | - Lucia Amadori
- Department of Integration, Intermediate Care Programme, AUSL Bologna, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Italy.
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6
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Koshida Y, Nishimura M, Kanazawa K. Do you know the diagnostic importance of susceptibility-weighted imaging on MRI for patients with cerebral fat embolism? Clin Case Rep 2023; 11:e7813. [PMID: 37636891 PMCID: PMC10448136 DOI: 10.1002/ccr3.7813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 08/29/2023] Open
Abstract
Key Clinical Message If you suspect cerebral fat embolism (CFE) of the diagnosis for the patients who present with impaired consciousness and hypoxia following a fracture, susceptibility-weighted imaging should be included of head MRI imaging. Abstract We report a case of cerebral fat embolism (CFE) that could be identified only by susceptibility-weighted imaging (SWI). Collection and analysis of previous case reports of CFE revealed utilization of SWI in less than one third of suspected cases, despite its known diagnostic ability for CFE.
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Affiliation(s)
- Yuki Koshida
- Department of General Internal MedicineKakogawa City HospitalKakogawaJapan
| | | | - Kenji Kanazawa
- Department of General Internal MedicineKakogawa City HospitalKakogawaJapan
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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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8
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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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9
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Devastating neurologic injury associated with fat embolism syndrome. J Am Assoc Nurse Pract 2023; 35:159-162. [PMID: 36487192 DOI: 10.1097/jxx.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022]
Abstract
ABSTRACT The diagnosis of fat embolism syndrome (FES) may present with a constellation of symptoms and continues to be a diagnosis of exclusion. Fat embolism syndrome is a poorly understood syndrome, which is typically associated with orthopedic trauma, most commonly with long bone fractures. Understanding the presentation of FES is essential to provide timely and appropriate interventions and to ensure optimal patient outcomes. The following is a case report of FES in a 39-year-old man following a motor vehicle collision in which he sustained a comminuted fracture of the right femur. The patient was subsequently diagnosed with FES using Gurd criteria in conjunction with frequent assessment of the patient's clinical picture, as well as exclusion of other differential diagnoses. Nurse practitioners and other providers should understand the constellation of symptoms that may be associated with FES to improve prevention and ensure timely intervention.
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Palasamudram Kumaran S, Reddy K S, Harish P, Ghosal N, Nagappa Sriramanakoppa N. Fat in the brain: Facts and features. Neuroradiol J 2023:19714009221150848. [PMID: 36609194 DOI: 10.1177/19714009221150848] [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: 01/09/2023] Open
Abstract
The presence of fat within a lesion in the brain is not only easy to identify on both CT/MRI but also can help narrow the differential. The purpose of this paper is to illustrate the spectrum of common and rare fat-containing lesions in the brain that are encountered in clinical practice. This paper intends to discuss 15 such lesions which are confirmed by MRI findings and histopathological correlation. We divided the spectrum of fat-containing lesions into lesions with adipose cells, lesions with cholesterol-rich content and tumours with lipomatous differentiation/transformation. Knowledge of these common and rare fat-containing lesions is essential for making the right diagnosis or narrowing the differential diagnosis.
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Affiliation(s)
- Sunitha Palasamudram Kumaran
- Department of Radiology, 422627Sri Sathya Sai Institute of Higher Medical Sciences Whitefields, Bangalore, India
| | - Shreyas Reddy K
- Department of Radiology, 29157St John's Medical College Hospital, Bangalore, India
| | - Priyadarshini Harish
- Department of Radiology, 422627Sri Sathya Sai Institute of Higher Medical Sciences Whitefields, Bangalore, India
| | - Nandita Ghosal
- Department of Pathology, 422627Sri Sathya Sai Institute of Higher Medical Sciences Whitefields, Bangalore, India
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Jain V, Remley W, Bunag C, Rodriguez E, Albayram MS, Wilson C, Patterson A, Bonnell G, Okun MS, Patel B. Clinical Reasoning: A Case of Acute Akinetic Mutism and Encephalopathy. Neurology 2022; 99:761-766. [PMID: 36008149 PMCID: PMC9620815 DOI: 10.1212/wnl.0000000000201207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/21/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Varun Jain
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville.
| | - William Remley
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
| | - Cyra Bunag
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
| | - Elsa Rodriguez
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
| | - Mehmet S Albayram
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
| | - Christina Wilson
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
| | - Addie Patterson
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
| | - Gabriel Bonnell
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
| | - Michael S Okun
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
| | - Bhavana Patel
- From the Department of Neurology (V.J., C.B., E.R., C.W., A.P., G.B., M.S.O., B.P.), University of Florida, Gainesville; Lake Erie College of Osteopathic Medicine (W.R.), Bradenton, FL; and Department of Radiology (M.S.A.), University of Florida, Gainesville
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12
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Gibbons P, Kennedy M, Borczuk P, Baymon D. Cerebral Fat Embolism After a Fall. J Emerg Med 2022; 63:e87-e90. [DOI: 10.1016/j.jemermed.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/20/2022] [Accepted: 07/09/2022] [Indexed: 11/06/2022]
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13
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Kristiansen S, Storm B, Dahle D, Domaas Josefsen T, Dybwik K, Nilsen BA, Waage-Nielsen E. Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model. Scand J Trauma Resusc Emerg Med 2021; 29:172. [PMID: 34930433 PMCID: PMC8686379 DOI: 10.1186/s13049-021-00986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Intraosseous cannulation can be life-saving when intravenous access cannot be readily achieved. However, it has been shown that the procedure may cause fat emboli to the lungs and brain. Fat embolization may cause serious respiratory failure and fat embolism syndrome. We investigated whether intraosseous fluid resuscitation in pigs in hemorrhagic shock caused pulmonary or systemic embolization to the heart, brain, or kidneys and if this was enhanced by open chest conditions. METHODS We induced hemorrhagic shock in anesthetized pigs followed by fluid-resuscitation through bilaterally placed tibial (hind leg) intraosseous cannulas. The fluid-resuscitation was limited to intraosseous or i.v. fluid therapy, and did not involve cardiopulmonary resuscitation or other interventions. A subgroup underwent median sternotomy with pericardiectomy and pleurotomy before hemorrhagic shock was induced. We used invasive hemodynamic and respiratory monitoring including Swan Ganz pulmonary artery catheter and transesophageal echocardiography and obtained biopsies from the lungs, heart, brain, and left kidney postmortem. RESULTS All pigs exposed to intraosseous infusion had pulmonary fat emboli in postmortem biopsies. Additionally, seven of twenty-one pigs had coronary fat emboli. None of the pigs with open chest had fat emboli in postmortem lung, heart, or kidney biopsies. During intraosseous fluid-resuscitation, three pigs developed significant ST-elevations on ECG; all of these animals had coronary fat emboli on postmortem biopsies. CONCLUSIONS Systemic fat embolism occurred in the form of coronary fat emboli in a third of the animals who underwent intraosseous fluid resuscitation. Open chest conditions did not increase the incidence of systemic fat embolization.
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Affiliation(s)
- Steinar Kristiansen
- Surgery and Intensive Care Unit, University Hospital of Northern Norway, Tromsø, Norway.
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway.
- Department of Clinical Medicine, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway.
| | - Benjamin Storm
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway
- Research Laboratory, Nordland Hospital Trust, Bodø, Norway
| | - Dalia Dahle
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | | | - Knut Dybwik
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Erik Waage-Nielsen
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway
- Research Laboratory, Nordland Hospital Trust, Bodø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
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Reply to the letter: "Letter to the editor regarding differentiating fat embolism from critical illness associated cerebral microbleeds.". Clin Imaging 2021; 83:194. [PMID: 34635370 DOI: 10.1016/j.clinimag.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
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