Neuroimaging findings in a case of cerebral fat embolism syndrome with delayed recovery

Abstract

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.

Risk Factors of Fat Embolism Syndrome After Trauma

“…1,7,9 The in-hospital mortality rate of 5.8% in the current study was relatively low compared with other studies on FES. 3,13 This distinction might be related to the generalized use of early internal skeletal fixation, which contributes to the prevention of fat embolism, and the…”

Intraosseous fluid resuscitation causes systemic fat emboli in a porcine hemorrhagic shock model

“…The more common symptoms from fat embolism syndrome such as respiratory failure and neurological symptoms have low sensitivity, with the typical petechial rash having higher spesifisity but occurring in only 20–50% of patients [ 33 ]. As cerebral fat emboli cause petechial hemorrhages, magnetic resonance imaging (MRI) with susceptibility weighted imaging (SWI) is perhaps the most valuable diagnostic tool in living patients [ 13 , 32 , 34 ]. However, our experience is that magnetic resonance imaging with SWI weighted imaging is not routinely performed, and further, that MRI is obtained only rarely if fat embolism syndrome is suspected (Fig.…”

Neurological effects of fat embolism syndrome: A case report

“…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…”