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.
Goldenhar syndrome involves multiple facial, cardiac, renal and neurological deficits which generally culminate into difficult ventilation and intubation. Various devices have been reported, in successfully securing the airway of these children. In our case we have preferred CMAC laryngoscope in securing the difficult paediatric airway and have found it effective, safe and less cumbersome than the traditional direct laryngoscopy.
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