scholarly journals Fat Embolism and Nonconvulsive Status Epilepticus

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yanetsy Olivera Arencibia ◽  
Mai Vo ◽  
Jennifer Kinaga ◽  
Jorge Uribe ◽  
Gloria Velasquez ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Supportive Therapy ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Nonconvulsive Status Epilepticus ◽  
Altered Level ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Wide Range

Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier. Continued neuromonitoring revealed nonconvulsive status epilepticus. Magnetic resonance imaging of the brain showed multiple bilateral acute cerebral infarcts with a specific pattern favoring the diagnosis of fat embolism syndrome. He was found to have a significant right to left intracardiac shunt on a transesophageal echocardiogram. He improved substantially over time with supportive therapy, was successfully extubated on day 6, and discharged to inpatient rehabilitation on postoperative day 15. Fat embolisms can result in a wide range of neurologic manifestations. Nonrefractory nonconvulsive status epilepticus that responds to antiepileptic drugs, sedation, and supportive therapy can have a favorable outcome. A high index of suspicion and early recognition reduces the chances of unnecessary interventions and may improve survival.

An Early Case of Fat Embolism Syndrome Occurring Following Polytrauma

2020 ◽  
pp. 000313482094364 ◽  
Author(s):  
Janelle-Cheri A. Millen ◽  
Carrie Watson ◽  
John M. Cain ◽  
Joshua Hagan ◽  
Winston T. Richards ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Mental Status ◽  
Brain Magnetic Resonance Imaging ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Long Bone ◽  
Status Change ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Maximal Medical Therapy

Fat embolism syndrome (FES) is a clinical entity occurring due to the presence of fat particles in the microcirculation, typically manifesting 12-72 hours after long bone trauma with respiratory distress, altered mental status, and petechial rash. Our case is that of a 17-year-old girl who suffered multiple orthopedic injuries without intracranial trauma after being a pedestrian struck by a vehicle. Despite presenting with a normal Glasgow Coma Score (GCS), within 4 hours of presentation, she was noted to have an acute mental status change to a GCS 7 with a normal computed tomography brain. Magnetic resonance imaging of the brain was suggestive of FES which, in this patient, had a rapidly progressing course with the development of severe cerebral edema and intracranial hypertension refractory to maximal medical therapy. Our patient required bilateral craniectomies for intracranial decompression and progressed over a 2-month hospital course to have subsequent cranioplasty and functional neurologic improvement. FES requires a high index of clinical suspicion in the presence of long bone fracture with unexplained altered mental status. The clinical course can be rapidly progressing with the development of intracranial hypertension which may benefit from surgical decompression with optimistic prognosis.

scholarly journals Fat Embolism Syndrome Mimicking a COVID-19 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Alexandru Leonard Alexa ◽  
Adela Hilda Onutu
Keyword(s):  
Intensive Care ◽  
Mental Status ◽  
Bone Fractures ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Multiple Organ ◽  
Long Bone ◽  
Fat Embolism Syndrome ◽  
Orthopedic Procedure ◽  
Embolism Syndrome

Fat embolism syndrome (FES) is a multiple organ disorder that can appear after pelvic and long bone fractures. The most common clinical finding is hypoxia, accompanied by diffuse petechiae, alveolar infiltrates, altered mental status, fever, polypnea, and tachycardia. We present a mild FES case on a 32-year-old man with no medical history admitted for an orthopedic procedure, following both tibia and fibulae fractures. Thirty hours postoperatively, he developed respiratory failure with altered mental status and needed admission in the intensive care unit. The chest radiography and later chest tomography raised the suspicion of a COVID-19 disease, even if our first suspicion was FES. After being carefully investigated in a dedicated COVID-19 ward and three negative RT-PCR SARS-CoV-2 tests, he returned to continue supportive treatment in the orthopedic intensive care ward. His evolution was favorable with discharge at ten days, without sequelae. In the context of the SARS CoV-2 pandemic, differential diagnosis has become an increasingly challenging process. Added to the variety of preexisting respiratory diseases and disorders, the COVID-19 infection, with its symptomatology so similar to multiple other pulmonary diseases, must not cloud our clinical judgement.

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management

2013 ◽  
Vol 119 (5) ◽  
pp. 1263-1270 ◽  
Author(s):  
Robert G. Kellogg ◽  
Ricardo B. V. Fontes ◽  
Demetrius K. Lopes
Keyword(s):  
Intracranial Pressure ◽  
Mental Status ◽  
Right Hemisphere ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Decompressive Hemicraniectomy ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Seizure Episode ◽  
The Right

Fat embolism syndrome (FES) is a common clinical entity that can occasionally have significant neurological sequelae. The authors report a case of cerebral fat embolism and FES that required surgical management of intracranial pressure (ICP). They also discuss the literature as well as the potential need for neurosurgical management of this disease entity in select patients. A 58-year-old woman presented with a seizure episode and altered mental status after suffering a right femur fracture. Head CT studies demonstrated hypointense areas consistent with fat globules at the gray-white matter junction predominantly in the right hemisphere. This CT finding is unique in the literature, as other reports have not included imaging performed early enough to capture this finding. Brain MR images obtained 3 days later revealed T2-hyperintense areas with restricted diffusion within the same hemisphere, along with midline shift and subfalcine herniation. These findings steered the patient to the operating room for decompressive hemicraniectomy. A review of the literature from 1980 to 2012 disclosed 54 cases in 38 reports concerning cerebral fat embolism and FES. Analysis of all the cases revealed that 98% of the patients presented with mental status changes, whereas only 22% had focal signs and/or seizures. A good outcome was seen in 57.6% of patients with coma and/or abnormal posturing on presentation and in 90.5% of patients presenting with mild mental status changes, focal deficits, or seizure. In the majority of cases ICP was managed conservatively with no surgical intervention. One case featured the use of an ICP monitor, while none featured the use of hemicraniectomy.

Brain Fat Embolism

2012 ◽  
Vol 25 (2) ◽  
pp. 193-199 ◽  
Author(s):  
N. Decaminada ◽  
M. Thaler ◽  
R. Holler ◽  
A. Salsa ◽  
C. Ladiges ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Bone Fractures ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Restricted Diffusion ◽  
Long Bone ◽  
Cytotoxic Edema ◽  
Centrum Semiovale ◽  
Embolism Syndrome ◽  
Wide Range

Fat embolism syndrome [FES] is an uncommon but serious complication of traumatic injures, which can follow a wide range of other surgical and medical conditions and can manifest with a collection of respiratory, hematological, neurological and cutaneous symptoms. FES should be suspected in all cases of traumatic injures with altered mental status following a period of normal neurological function, especially after orthopedic fixation of long bone fractures. Neurological symptoms must not be related to the initial trauma. The objective of this study was to describe the characteristics of FES and to correlate the neuroradiological findings with the clinical symptoms and the outcome of two cases of cerebral FES which occurred in two young men after bone fractures of the extremities without cranial traumatism. Both patients were studied by brain computed tomography (CT) and by brain magnetic resonance (MR). While Cerebral CT was inadequate to the diagnosis, Cerebral MR, performed 48 hours after injury, showed several focal areas of pathological signal in the white matter of the subcortical, periventricular and centrum semiovale regions, as well as in the basal ganglia and cerebellum. The neuroradiological findings of the two patients were compared with their clinical symptoms and outcome. The patient with the worst prognosis showed more lesions on MR and a restricted diffusion on DWI-MR, due to cytotoxic edema, whereas the patient with the better outcome showed lesions due to vasogenetic edema without any restricted diffusion. Cerebral MR and DW-MR are sensitive indicators for the early diagnosis of FES and can give a vast amount of information on the prognosis and future outcome.

Nonconvulsive status epilepticus in cancer patients with altered mental status.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e13028-e13028
Author(s):  
Barbara Jane O'Brien ◽  
Jacob Joseph Mandel ◽  
Tummala Sudhakar ◽  
John Frederick De Groot
Keyword(s):  
Status Epilepticus ◽  
Cancer Patients ◽  
Mental Status ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus

scholarly journals Liposuction-Induced Fat Embolism Syndrome: A Brief Review and Postmortem Diagnostic Approach

2018 ◽  
Vol 142 (7) ◽  
pp. 871-875 ◽  
Author(s):  
Colby A. Cantu ◽  
Elizabeth N. Pavlisko
Keyword(s):  
Supportive Therapy ◽  
Signs And Symptoms ◽  
The United States ◽  
Fat Embolism ◽  
Specific Therapy ◽  
Fat Embolism Syndrome ◽  
Neurologic Impairment ◽  
Embolism Syndrome ◽  
Life Threatening ◽  
Elective Procedure

Lipoplasty, or liposuction, the surgical process of removing excess fat, is an elective procedure with rising frequency in the United States. Fat embolism syndrome is a clinical diagnosis and is defined as fat in the circulation with an identifiable clinical pattern of signs and symptoms (eg, hypoxemia, respiratory insufficiency, neurologic impairment, and petechial rash) that occur in the appropriate clinical context. Fat embolism syndrome following liposuction is a life-threatening complication, although its incidence is low. Currently, there is no specific therapy for fat embolism syndrome, so prevention, early detection, and supportive therapy are critical. Many cases of fat embolism syndrome are undiagnosed or misdiagnosed; however, postmortem examination can provide the means for appropriate diagnosis. Therefore, a pathologist must keep a keen eye, as microscopic fat emboli are difficult to appreciate with routine tissue processing and staining.

Clinical Characteristics and Nonconvulsive Seizures in Young Children With Abusive Head Trauma

2019 ◽  
Vol 34 (12) ◽  
pp. 713-719
Author(s):  
Ahyuda Oh ◽  
Larry D. Olson ◽  
Joshua J. Chern ◽  
Hyunmi Kim
Keyword(s):  
Status Epilepticus ◽  
Head Trauma ◽  
Mental Status ◽  
Abusive Head Trauma ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus ◽  
Fisher Exact Test ◽  
Short Term ◽  
Nonconvulsive Seizures ◽  
The Impact

Aim: We aimed to evaluate putative predictors of symptoms and signs at admission for nonconvulsive seizure and to examine the impact of nonconvulsive seizures on short-term outcomes. Method: We retrospectively collected consecutive abusive head trauma patients (<36 months of age) from the trauma registry at Children’s Healthcare of Atlanta between 2009 and 2014. Multiple logistic regression was performed to assess the putative predictors for the occurrence of nonconvulsive seizures including clinical seizures, altered mental status, respiratory difficulty, and cardiac arrest at admission, while controlling for age, sex, and injury severity. The Mann-Whitney U test and the Fisher exact test were used to compare the short-term outcomes between patients with and without nonconvulsive seizures. Results: Two hundred seventy patients with abusive head trauma were identified (male = 55.6%). The median age was 4 months (interquartile range = 2-8 months). Among 70 patients who underwent continuous electroencephalography (EEG), 40 had nonconvulsive seizures (57%) and 21 developed nonconvulsive status epilepticus (30%). Altered mental status at admission was associated with the occurrence of nonconvulsive seizures (odds ratio = 6.8, 95% confidence interval = 1.2-38.2, P = .03). Comparing patients with no seizures, those with nonconvulsive seizures were more likely to stay longer at hospital (9 days vs 14 days, P = .04) and to need rehabilitation (50.0% vs 63.2%, P = .03). Conclusions: Nonconvulsive seizures and nonconvulsive status epilepticus was highly prevalent in young pediatric patients with abusive head trauma. Presenting with altered mental status at admission was found to predict the occurrence of nonconvulsive seizures. Nonconvulsive seizures had an unfavorable impact on short-term outcomes.

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