Fat Emboli Syndrome in a Child with Duchenne Muscular Dystrophy After Minor Trauma

Stein, Loretta; Herold, Richard; Austin, Andrea; Beer, William M.

doi:10.1016/j.jemermed.2016.01.030

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…Recently, Stein et al 11 described a case report about a patient with DMD exhibiting cardiopulmonary, neurologic and visual signs consistent with FES after minor trauma.…”

Section: Resultsmentioning

confidence: 99%

Fat embolism after fractures in Duchenne muscular dystrophy: an underdiagnosed complication? A systematic review

Feder

Koch

Palmieri

et al. 2017

TCRM

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Duchenne muscular dystrophy is the most frequent lethal genetic disease. Several clinical trials have established both the beneficial effect of steroids in Duchenne muscular dystrophy and the well-known risk of side effects associated with their daily use. For many years it has been known that steroids associated with ambulation loss lead to obesity and also damage the bone structure resulting in the bone density reduction and increased incidence of bone fractures and fat embolism syndrome, an underdiagnosed complication after fractures. Fat embolism syndrome is characterized by consciousness disturbance, respiratory failure and skin rashes. The use of steroids in Duchenne muscular dystrophy may result in vertebral fractures, even without previous trauma. Approximately 25% of patients with Duchenne muscular dystrophy have a long bone fracture, and 1% to 22% of fractures have a chance to develop fat embolism syndrome. As the patients with Duchenne muscular dystrophy have progressive cardiac and respiratory muscle dysfunction, the fat embolism may be unnoticed clinically and may result in increased risk of death and major complications. Different treatments and prevention measures of fat embolism have been proposed; however, so far, there is no efficient therapy. The prevention, early diagnosis and adequate symptomatic treatment are of paramount importance. The fat embolism syndrome should always be considered in patients with Duchenne muscular dystrophy presenting with fractures, or an unexplained and sudden worsening of respiratory and cardiac symptoms.

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“…Recently, Stein et al 11 described a case report about a patient with DMD exhibiting cardiopulmonary, neurologic and visual signs consistent with FES after minor trauma.…”

Section: Resultsmentioning

confidence: 99%

Fat embolism after fractures in Duchenne muscular dystrophy: an underdiagnosed complication? A systematic review

Feder

Koch

Palmieri

et al. 2017

TCRM

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“…In one case series, five patients aged 14-23 years were found to have FES with respiratory and neurologic symptoms after minor trauma. There are also reports of fatal FES after minor trauma among DMD patients 9,10 . Notably, none had clear fractures on imaging and/or autopsy 9 .…”

Section: Discussionmentioning

confidence: 99%

Clinical Reasoning: Patient With Prior Spinal Cord Injury Who Developed Altered Mental Status After a Fall

Dessy¹,

Bhagat

Czeisler

2022

Neurology

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An 18-year-old male with a history of complete traumatic spinal cord injury (SCI) at C5-C7 three years prior presented with unresponsiveness and hypoxia after a fall. There were no overt signs of bruising or swelling. After extensive and unrevealing initial workup, MRI brain without contrast showed numerous diffusely scattered punctate foci of diffusion restriction and evidence of numerous microhemorrhages. A full body skeletal survey revealed mildly impacted, nondisplaced, incomplete fractures in the distal femoral metaphyses bilaterally. This case presentation discusses specific considerations for patients with SCI, reviewing the differential diagnosis, workup and management of altered mental status after minor falls or other trauma in this population.

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“…The other cases occurred while walking, during physical therapy, and during assisted transfers. [6][7][8][9][10][11][12] In these cases, FES had a guarded prognosis, with 7 of the 18 patients dying and 1 of the patients remaining in a persistent vegetative state. 8,9 While caution is warranted in generalizing these findings, given the small number of reported cases and likely publication bias, education of caregivers and patients on use of restraints and safe transfers is paramount to limit the risk of trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Two‐thirds of these cases occurred when an unrestrained patient fell from their wheelchair. The other cases occurred while walking, during physical therapy, and during assisted transfers 6–12 . In these cases, FES had a guarded prognosis, with 7 of the 18 patients dying and 1 of the patients remaining in a persistent vegetative state 8,9 .…”

Section: Discussionmentioning

confidence: 99%

A traumatic traveler

Abney

Monash

Trappey

et al. 2020

Journal of Hospital Medicine

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Fat Emboli Syndrome in a Child with Duchenne Muscular Dystrophy After Minor Trauma

Cited by 7 publications

References 15 publications

Fat embolism after fractures in Duchenne muscular dystrophy: an underdiagnosed complication? A systematic review

Fat embolism after fractures in Duchenne muscular dystrophy: an underdiagnosed complication? A systematic review

Clinical Reasoning: Patient With Prior Spinal Cord Injury Who Developed Altered Mental Status After a Fall

A traumatic traveler

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