Post‐traumatic cerebral fat embolism syndrome with a favourable outcome: a case report

Abstract

Background Fat embolism syndrome (FES) is a change in physiology resulting from mechanical causes, trauma, or sepsis. Neurological manifestations of FES can vary from mild cognitive changes to coma and even cerebral oedema and brain death. Here, we present an unusual case of cerebral fat emboli that occurred in the absence of acute chest syndrome or right-to-left shunt. Case presentation A previously healthy 57-year-old right-handed male was admitted to our department because of unconsciousness after a car accident for 3 days. He suffered from multiple fractures of the bilateral lower extremities and pelvis. This patient had severe anaemia and thrombocytopenia. Head MRI showed multiple small lesions in the whole brain consistent with a “star field” pattern, including high signals on T2-weighted (T2w) and fluid-attenuated inversion recovery (FLAIR) images in the bilateral centrum semiovale; both frontal, parietal and occipital lobes; and brainstem, cerebellar hemisphere, and deep and subcortical white matter. Intravenous methylprednisolone, heparin, mannitol, antibiotics and nutritional support were used. Although this patient had severe symptoms at first, the outcome was favourable. Conclusions When patients have long bone and pelvic fractures, multiple bone fractures and deteriorated neurological status, cerebral fat embolism (CFE) should be considered. Additionally, CFE may occur without an intracardiac shunt. The early diagnosis and appropriate management of FES are important, and prior to and following surgery, patients should be monitored comprehensively in the intensive care unit. With appropriate treatment, CFE patients may achieve good results.

Can the rate of mortality and neurological recovery be predicted from the time of onset of symptoms and MRI grade in patients with cerebral fat embolism?

“…there are reports in the literature of high iCp in Cfes being managed with hemicraniectomy after medical management was inadequate, 23 and with the use of prednisolone, heparin, and mannitol as neuroprotective medications. 24 However, in our series, the iCp was not measured since the head injury was not significant.…”

Susceptibility-weighted imaging of cerebral fat embolism: A case report

“…FES is a serious fracture-related complication, which usually occurs between 24 and 72 hours after injury, with a classic triad of respiratory manifestations (95%), cerebral effects (60%), and petechiae (33%). [ 2 ] Neurological manifestations of FES can vary from mild cognitive changes to coma and even cerebral edema and brain death. [ 4 ] In the early stage, CFE was considered to be the brain manifestation of FES; however, some patients showed mild systemic symptoms despite extensive intracranial embolization.…”

“…[ 1 ] As there are no characteristic signs in clinical presentation or routine brain imaging, CFE is difficult to diagnose. [ 2 ] Following the development of MRI, it was found that susceptibility-weighted imaging (SWI) can reveal specific features of CFE, thus having the potential to be used as a new tool for diagnosing this disease. [ 3 ] Herein, we reported on a case suffering from CFE and discussed the use of SWI in CFE.…”

Do you know the diagnostic importance of susceptibility weighted imaging on MRI for patients with cerebral fat embolism?

“…We performed a filtered search for "within 5 years" and "case report" using the keywords "cerebral fat embolism" and "MRI" in a PubMed search. Of 42 cases of cerebral fat embolism included in 39 papers 3-41 , we analyzed 33 cases [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][19][20][21][22][23][24][25][26][28][29][30]32,34,37,39,40 after excluding the following: (1) cases not available (n = 2) 27,35 , (2) not a case report (n = 1) 33 , (3) not in English (n = 1) 18 , (4) not cerebral fat embolism (n = 3) 36,38,41 , (5) diagnosis obtained by CT instead of MRI (n = 1) 32 , and (6) MRI contraindicated due to a magnetic implant (n = 1) 31 . Of the 33 cases, SWI of the brain was acquired in 10 cases 4,5,10,12,17,25,34,36,37,…”