Altered Mental Status as Initial Presentation of Fat Embolism Syndrome in Sickle Cell Crisis

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.

Download Full-text

An Early Case of Fat Embolism Syndrome Occurring Following Polytrauma

The American Surgeon ◽

10.1177/0003134820943644 ◽

2020 ◽

pp. 000313482094364 ◽

Cited By ~ 1

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.

Download Full-text

Fat Embolism Syndrome Mimicking a COVID-19 Infection

Case Reports in Critical Care ◽

10.1155/2021/5519812 ◽

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.

Download Full-text

Massive cerebral involvement in fat embolism syndrome and intracranial pressure management

Journal of Neurosurgery ◽

10.3171/2013.7.jns13363 ◽

2013 ◽

Vol 119 (5) ◽

pp. 1263-1270 ◽

Cited By ~ 27

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.

Download Full-text