Favorable Outcome of Cerebral Fat Embolism Syndrome with a Glasgow Coma Scale of 3: a Case Report and Review of the Literature

Lin, Keng-Yi; Wang, Kai-Chen; Chen, Yao‐Li; Lin, Ping‐Yi; Lin, Kuo‐Hua

doi:10.1007/s12262-014-1109-3

Cited by 5 publications

(9 citation statements)

References 9 publications

(11 reference statements)

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“…10 Fortunately, even significant cerebral FES appears to be reversible and full recovery possible, though one case with multiple lower limb fractures took a period of six months to regain full functional status. [2][3][4]9,11,12 The mortality of FES is less than 10% in the context of supportive care. 4…”

Section: Discussionmentioning

confidence: 99%

Neurological effects of fat embolism syndrome: A case report

Shacklock

Gemmell

Hollister

2017

Journal of the Intensive Care Society

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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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Section: Discussionmentioning

confidence: 99%

Neurological effects of fat embolism syndrome: A case report

Shacklock

Gemmell

Hollister

2017

Journal of the Intensive Care Society

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“…MRI is more sensitive and recommended as the initial imaging modality in patients with clinically suspicious CFE. 6,[15][16][17] On DWI, CFE presents typically with the starfield pattern of scattered bright spots on a dark background; thus, DWI should be performed in all patients with deteriorated mental status after a long bone fracture. 15,16 There are two widely accepted mechanisms of CFES: the mechanical and biochemical theories.…”

Section: Discussionmentioning

confidence: 99%

“…6,[15][16][17] On DWI, CFE presents typically with the starfield pattern of scattered bright spots on a dark background; thus, DWI should be performed in all patients with deteriorated mental status after a long bone fracture. 15,16 There are two widely accepted mechanisms of CFES: the mechanical and biochemical theories. 1,3,9,[14][15][16][17][18][19] The mechanical theory states that fat particles released from the bone marrow of damaged bone escape to the systemic circulation through a damaged vein and finally cause obstruction of cerebral blood vessel.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 There are two widely accepted mechanisms of CFES: the mechanical and biochemical theories. 1,3,9,[14][15][16][17][18][19] The mechanical theory states that fat particles released from the bone marrow of damaged bone escape to the systemic circulation through a damaged vein and finally cause obstruction of cerebral blood vessel. This theory is based on the existence of AVM or cardiac shunting as the pathway of fat particles to venous circulation.…”

Section: Discussionmentioning

confidence: 99%

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<p>Extremely Acute-Onset Cerebral Fat Embolism</p>

Tsuru¹,

Adachi²

2020

IJGM

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Cerebral fat embolism (CFE) causes the neurological involvement observed in fat embolism syndrome, which is a post-traumatic complication seen mostly after long bone fractures and usually presents 24-72 h after the injury. An early 80s female who sustained an isolated traumatic fracture of the left distal femur without dislocation was alert on admission but fell into a coma 55 min after the injury. Brain computed tomography showed no abnormalities. Brain magnetic resonance imaging was performed approximately 5 h after the accident, and diffusion-weighted images revealed hyperintense, dot-like lesions disseminated in a "starfield" pattern in the brain. The patient was diagnosed with CFE and admitted to the intensive care unit. The day after the injury, the patient developed petechiae on the palpebral conjunctiva and was still comatose 4 months after the trauma. The current patient developing CFE in less than 1 h after a traumatic injury illustrates that CFE should be considered in patients with sudden deterioration of consciousness within 1 h after long bone fractures.

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“…CFE is usually a self-limiting condition with a favorable prognosis characterized by complete recovery within a few weeks/months or years 34,35,73. However, it may also be characterized by an ominous prognosis with a mortality rate of up to 10%, above all in patients with increased age and multiple preexisting medical diseases 5,8,13.…”

Section: Introductionmentioning

confidence: 99%

From the diagnosis to the therapeutic management: cerebral fat embolism, a clinical challenge

Scarpino¹,

Lanzo²,

Lolli³

et al. 2019

IJGM

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Cerebral fat embolism (CFE) is an uncommon incomplete type of fat embolism syndrome (FES), characterized by purely cerebral involvement. It usually occurs 12–72 hours after the initial trigger, mainly represented by closed, long-bone multiple fractures of the lower extremities. Neurological manifestations are mainly characterized by headache, confusion, seizures, focal deficit, and alteration of the consciousness state up to coma onset. It represents a diagnostic challenge, above all when secondary to uncommon nontraumatic causes, because neurological signs and symptoms are variable and nonspecific, not satisfying the Gurd and Wilson’s criteria, the diagnostic features most widely used today for FES diagnosis. Neuroimaging (mainly MRI, but in some cases, brain computed tomography too) can hasten the diagnosis, avoiding other unnecessary investigations and treatment. Usually self-limiting, CFE may sometimes be fatal. Treatment is to date mainly supportive and prophylactic strategies are considered an important tool to decrease the development of fat embolism and, consequently, the rate of CFE.

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Favorable Outcome of Cerebral Fat Embolism Syndrome with a Glasgow Coma Scale of 3: a Case Report and Review of the Literature

Cited by 5 publications

References 9 publications

Neurological effects of fat embolism syndrome: A case report

Neurological effects of fat embolism syndrome: A case report

<p>Extremely Acute-Onset Cerebral Fat Embolism</p>

From the diagnosis to the therapeutic management: cerebral fat embolism, a clinical challenge

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