Confusion after spine injury: cerebral fat embolism after traumatic rupture of a Tarlov cyst: Case report

Duja, Corina M; Berna, C.; Kremer, Stéphane; Geronimus, C.; Kopferschmitt, J.

doi:10.1186/1471-227x-10-18

Cited by 19 publications

(15 citation statements)

References 14 publications

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“…In our patient the sacral fracture involved the Tarlov cyst and we postulate that this fact likely resulted in a communication with the subarachnoid space that led to distant migration of fat from the bone marrow. The same mechanism was suspected in a case reported by Duja et al…”

Section: Commentsupporting

confidence: 68%

“…It usually presents as a multisystem disorder with diverse manifestations such as petechial rash, deteriorating mental status and progressive respiratory insufficiency. Central nervous system manifestations of fat embolism syndrome are nonspecific and variables: acute confusion after fall, headache, lethargy, irritability, delirium, stupor, convulsions or coma …”

Section: Commentmentioning

confidence: 99%

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Cerebral Fat Embolisms Secondary to Rupture of a Tarlov Cyst

Kortazar-Zubizarreta

Menoyo

Ojeda

et al. 2013

Journal of Neuroimaging

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Section: Commentsupporting

confidence: 68%

Section: Commentmentioning

confidence: 99%

Cerebral Fat Embolisms Secondary to Rupture of a Tarlov Cyst

Kortazar-Zubizarreta

Menoyo

Ojeda

et al. 2013

Journal of Neuroimaging

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“…Pain is usually intermittent and is most frequently exacerbated by standing, walking and coughing. Perineural cysts were initially described at the posterior sacral or coccygeal nerve roots [16]. As SESMCs with SNRFs develop over the long term, the motor and bowel/bladder nerve roots fibers may be compressed.…”

Section: Discussionmentioning

confidence: 99%

“…It is generally accepted that asymptomatic SESMCs do not require surgical intervention [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18][19]. When these lesions are symptomatic, the goals of surgical intervention are to relieve nerve stimulation and compression, and stop bone erosion.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of nerve root sheaths for sacral extradural spinal meningeal cysts with spinal nerve root fibers

Sun

Wang

et al. 2013

Sci. China Life Sci.

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This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths. The relationships between the cysts and spinal nerve root fibers were examined microscopically, the cysts were partially excised, and the defects were oversewn to reconstruct the nerve root sheaths. The Improved Japanese Orthopedic Association (IJOA) scoring system was used to evaluate preoperative and postoperative neurological function. Thirty-eight patients were included in this study, with a mean age of 41.4±15.57 years. The mean IJOA score was 18.8±1.32 preoperatively and 19.6±0.65 postoperatively, which was a significant difference (t=-3.77, P=0.001). These results indicate a significant improvement in neurological function after surgery. The most significant improvement in neurological function was sensation (z=-2.86, P=0.004), followed by bowel/bladder function (z=-2.31, P=0.02). The pathophysiological mechanism underlying the formation of SESMCs with SNRFs is congenital weakness of the nerve root sheath [3]. High hydrostatic pressure generated by upright walking and a ball-valve effect result in cyst enlargement [3][4][5]. The walls of the cysts are formed by enlargement of the perineural nerve root sheaths, resulting in alteration of the environment around the spinal nerve root fibers. This alteration causes malfunction of the involved spinal nerve root fibers, similar to axonal transport dysfunction [6]. This malfunction differs from malfunction associated with compression against adjacent bone or other nerve

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“…A similar pattern was demonstrated only once in the literature but inside the ventricular system after cerebrospinal embolization of fat from a ruptured Tarlov cyst. 17 Guillevin et al may have described this pat tern before but unfortunately did not include the figure in their report.…”

mentioning

confidence: 87%

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management

Kellogg¹,

Fontes²,

Lopes³

2013

JNS

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Fat embolism syndrome (FES) is a common clinical entity that can occasionally have significant neurological sequelae. The authors report a case of cerebral fat embolism and FES that required surgical management of intracra nial pressure (ICP). They also discuss the literature as well as the potential need for neurosurgical management of this disease entity in select patients. A 58yearold woman presented with a seizure episode and altered mental status after suffering a right femur fracture. Head CT studies demonstrated hypointense areas consistent with fat globules at the graywhite matter junction predominantly in the right hemisphere. This CT finding is unique in the literature, as other reports have not included imaging performed early enough to capture this finding. Brain MR images obtained 3 days later revealed T2hyperintense areas with restricted diffusion within the same hemisphere, along with midline shift and subfalcine herniation. These findings steered the patient to the operating room for decompressive hemicraniec tomy. A review of the literature from 1980 to 2012 disclosed 54 cases in 38 reports concerning cerebral fat embolism and FES. Analysis of all the cases revealed that 98% of the patients presented with mental status changes, whereas only 22% had focal signs and/or seizures. A good outcome was seen in 57.6% of patients with coma and/or abnormal posturing on presentation and in 90.5% of patients presenting with mild mental status changes, focal deficits, or sei zure. In the majority of cases ICP was managed conservatively with no surgical intervention. One case featured the use of an ICP monitor, while none featured the use of hemicraniectomy.

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Confusion after spine injury: cerebral fat embolism after traumatic rupture of a Tarlov cyst: Case report

Cited by 19 publications

References 14 publications

Cerebral Fat Embolisms Secondary to Rupture of a Tarlov Cyst

Cerebral Fat Embolisms Secondary to Rupture of a Tarlov Cyst

Reconstruction of nerve root sheaths for sacral extradural spinal meningeal cysts with spinal nerve root fibers

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management

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