Background and Goal of Study:
Fat emboli syndrome follows long bone fractures. Its classic presentation consists of an asymptomatic interval followed by pulmonary and neurologic manifestations combined with petechial haemorrhages. Cerebral fat embolism occurring before operative repair without shunt lesion is rarely reported. We report a patient with a posttraumatic cerebral fat embolism resulting in severe neurologic dysfunction.
A 27-year-old man was brought to the hospital immediately after a traffic accident. He sustained a right segmental femoral shaft fracture. The patient was alert with no neurological deficits.38 hours after injury, the patient developed acute mental status deterioration dyspnoea and a petechial rash appeared on his chest, shoulders, upper arms and conjunctivae. Magnetic resonance imaging (MRI) of the brain revealed diffuse white matter cytotoxic edema. Computed tomography with intravenous contrast revealed no evidence of embolism in the lung, abdomen, and pelvis. Transthoracic and transesophageal echocardiogram revealed no circulating embolic particles or intracardiac shunt. The patient underwent closed reduction and internal fixation with a reamed intramedullary nail in the femur at 5 days after injury. Supportive medical treatment included deep sedation, mechanical ventilatory support and hypothermia that was induced with intravascular heat exchange catheter in order to control the raised intracranial pressure (ICP). Transcranial Doppler examination was performed on daily basis for the evaluation of cerebral oedema and ICP.
The MRI of the brain performed 22 days after the incident was normal. The patient was discharged from the hospital 50 days after admission. On follow-up 2 months later, he had returned to his daily activities.
Conclusions and Discussion:
The most effective prophylactic measure is to reduce long bone fractures as soon as possible. Cytotoxic cerebral oedema following cerebral fat embolism may be reversible. Induction of hypothermia has been effective in our case for oedema and raised ICP confrontation.
© 2012 European Society of Anaesthesiology