087 Cerebral fat embolism in a case of endoscopic oesophageal dilatation
IntroductionFat Embolism Syndrome (FES) is rare, usually occurring in the setting of long bone fractures or trauma. Furthermore, isolated neurological form or pure cerebral fat embolism (CFE) is an atypical presentation. The authors are not aware of any previously documented cases of endoscopy related CFE without accompanying trauma.CaseA 61 year old male presented for an elective endoscopy with dilatation for known oesophageal ulcer with stricturing. In post-operative recovery one hour post dilatation, he was found to have left sided weakness, aphasia and right fixed lateral gaze, NIHSS score of 18. He subsequently developed generalised tonic clonic seizures with reduced sensorium requiring intubation. CT brain was normal. MRI brain the following day showed bi-hemispheric punctate scattered white matter diffusion weighted restrictions (starfield pattern) characteristic for CFE. There were no signs of respiratory distress or petechial skin rash. Cardiac monitoring and transthoracic echocardiography with bubble test were normal.ConclusionThis case highlights a rare presentation of an uncommon syndrome, in a previously unidentified patient cohort, and the most appropriate investigation required to diagnose CFE.