Brain Fat Embolism

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.

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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.

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Fat Embolism and Nonconvulsive Status Epilepticus

Case Reports in Neurological Medicine ◽

10.1155/2018/5057624 ◽

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.

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Complications of fractures

10.1093/med/9780199550647.003.012002 ◽

2011 ◽

Author(s):

James Wilson-MacDonald ◽

Andrew James

Keyword(s):

Bone Fractures ◽

Fat Embolism ◽

Gas Gangrene ◽

Long Bone ◽

Vein Thrombosis ◽

Embolism Syndrome ◽

Tissue Removal ◽

Trophic Changes ◽

Prolonged Pain ◽

Deep Vein

♦ Fat embolism syndrome is defined as the presence of globules of fat in the lungs and in other tissues and occurs occasionally in long bone fractures♦ Reflex sympathetic dystrophy is characterized by intense prolonged pain, vasomotor disturbance, delayed functional recovery, and trophic changes♦ Avascular necrosis typically affects intra-articular bone after fracture and can occur in up to 70% of displaced talar neck fractures♦ Immobility associated with recovery from fracture is associated with deep vein thrombosis, which carries a risk of pulmonary embolism, and should be treated with anti-coagulants♦ Gas gangrene is a rapidly-spreading infection of devitalized tissue, removal of the affected area and treatment with penicillin is required♦ Compartment syndrome within a closed compartment can result in tissue ischaemia and necrosis followed by fibrosis and muscle contracture

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Timing of definitive fixation of major long bone fractures: Can fat embolism syndrome be prevented?

Injury ◽

10.1016/j.injury.2017.04.015 ◽

2017 ◽

Vol 48 ◽

pp. S3-S6 ◽

Cited By ~ 9

Author(s):

Taco J. Blokhuis ◽

Hans-Christoph Pape ◽

Jan-Paul Frölke

Keyword(s):

Bone Fractures ◽

Fat Embolism ◽

Long Bone ◽

Fat Embolism Syndrome ◽

Long Bone Fractures ◽

Embolism Syndrome

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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.

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Fat Embolism Syndrome: A Case Report and Review Literature

Case Reports in Medicine ◽

10.1155/2018/1479850 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Nattaphol Uransilp ◽

Sombat Muengtaweepongsa ◽

Nuttawut Chanalithichai ◽

Nattapol Tammachote

Keyword(s):

Bone Fractures ◽

Specific Treatment ◽

Fat Embolism ◽

Review Literature ◽

Long Bone ◽

Laboratory Findings ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

Neck Fracture ◽

Magnetic Resonance Imaging Mri

Fat embolism syndrome (FES) is a life-threatening complication in patients with orthopedic trauma, especially long bone fractures. The diagnosis of fat embolism is made by clinical features alone with no specific laboratory findings. FES has no specific treatment and requires supportive care, although it can be prevented by early fixation of bone fractures. Here, we report a case of FES in a patient with right femoral neck fracture, which was diagnosed initially by Gurd’s criteria and subsequently confirmed by typical appearances on magnetic resonance imaging (MRI) of the brain. The patient received supportive management and a short course of intravenous methylprednisolone.

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Abstract WP253: Diagnostic Evaluation and Outcome of Cerebral Fat Embolism: Single Center Retrospective Review

Stroke ◽

10.1161/str.51.suppl_1.wp253 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Breana L Taylor ◽

Arielle P Davis ◽

Steven R Peters ◽

Allison Kunze ◽

Amita Singh ◽

...

Keyword(s):

Orthopedic Surgery ◽

Bone Fractures ◽

Brain Mri ◽

Diagnostic Testing ◽

Retrospective Chart Review ◽

Altered Mental Status ◽

Fat Embolism ◽

Long Bone ◽

Mri Findings ◽

Diffusion Restriction

Introduction: Cerebral Fat Embolism (CFE) is an underappreciated complication of trauma and orthopedic surgery whose diagnosis is mostly based on clinical suspicion. The utility of diagnostic testing is poorly defined. Methods: Using discharge diagnosis codes and a stroke database at a Level 1 Trauma Center, we performed a retrospective chart review of diagnostic workup and outcome for CFE from 2005 to 2019. Among those with a diagnosis of systemic fat emboli syndrome after long-bone fracture, cerebral involvement was established based on altered mental status, retinal findings, brain MRI findings or a combination of these. This report focuses on those who had MRI, all of which had findings of CFE. Results: Forty patients with CFE were identified, comprising 0.3% of all patients admitted with long-bone fractures. Of these patients, the average age was 39 years (SD 22), 30 (75%) were men, 28 (70%) had hypoxemia, 2 (5%) had petechial rash, and 29 (73%) were comatose, including 16 (40%) following orthopedic surgery. Brain MRI findings of CFE included scattered diffusion-restriction (60%), confluent white-matter edema (33%) and diffuse petechial hemorrhage (30%), with 27% having multiple findings of CFE. Ophthalmologic evaluation revealed exudates or hemorrhage suggestive of Purtscher-like retinopathy in 20 (91%) of 22 patients examined. Transcranial doppler microembolic signals (MES) were detected in 17 (53%) of 32 patients examined and were associated with scattered diffusion-restriction on MRI (chi square, p =0.01). Twelve patients (30%) died before discharge, 15 (38%) were discharged to a nursing facility, 12 (30%) to a rehabilitation facility and 1 (3%) to home. After a mean of 5.4 months, 1 patient had died, 11 had severe disability and 16 had moderate disability or better. Conclusion: The diagnosis of CFE is complicated by unknown sensitivity of diagnostic modalities. Nonetheless, typical MRI and ophthalmologic findings can assist in diagnosis. MES are associated with scattered infarction on MRI, suggesting active disease. The outcome of patients with CFE is highly variable, and a better understanding of this potentially devastating disease will require studies with larger numbers of cases collected in a standard fashion at multiple trauma centers.

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Tactics of Operative Treatment for Closed Long Bone Fractures in Patients with Polytrauma in Early Period

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20031033-9 ◽

2003 ◽

Vol 10 (3) ◽

pp. 3-9

Author(s):

V A Sokolov ◽

E I Byalik ◽

V A Sokolov ◽

E I Byalik

Keyword(s):

Soft Tissues ◽

Bone Fractures ◽

Plate Osteosynthesis ◽

Early Period ◽

Functional Results ◽

Fat Embolism ◽

Long Bone ◽

Long Bone Fractures ◽

Embolism Syndrome ◽

Urgent Operation

Results of the treatment of 218 victims with polytrauma were analyzed during the period from 1998 to 2202. There were 127 patients with one and 91 patients with several closed fractures. Authors consider osteosynthesis for closed long bone fractures to be an urgent operation of third term. Osteosynthesis is absolutely indicated to the patients with psychomotor excitation, in cases of the threat for skin perforation by bone fragments and in patients requiring intensive nursing for their life rescue. The choice of operative method depends on polytrauma severity and fracture type. When osteosynthesis is performed by urgent indications in patients with polytrauma the requirements to osteosynthesis stiffness are higher than in isolate injuries, as the rotation displacement, migration and fixator deformity frequently take place in unconscious patients who need constant intensive nursing. In patients with concomitant thorax injury urgent intramedullar osteosynthesis by nail is contraindicated due to the possibility of fat embolism syndrome development. In these patients plate osteosynthesis is preferred. If there are no absolute indications to urgent osteosynthesis this operation could be performed on 3-10 days after trauma using lightly traumatic and invasive methods not waiting for the complete normalization of homeostasis parameters and restoration of soft tissues in the fracture zone. In closed long bone fractures tactics of early osteosynthesis allows to decrease the rate of hypostatic complications and mortality by more than 10% and achieve good functional results.

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Cerebral fat embolism syndrome (FES): similar cases with different outcomes

BMJ Case Reports ◽

10.1136/bcr-2018-225261 ◽

2018 ◽

pp. bcr-2018-225261

Author(s):

Alexis Jorgensen ◽

Azhar Bashir ◽

Jibanananda Satpathy

Keyword(s):

Bone Fractures ◽

Plate Osteosynthesis ◽

Neurological Impairment ◽

Fat Embolism ◽

Sudden Onset ◽

Clinical Syndrome ◽

Long Bone ◽

Fat Embolism Syndrome ◽

Long Bone Fractures ◽

Embolism Syndrome

Fat embolism syndrome (FES) is a rare multisystem, clinical syndrome occurring in 0.9%–2.2% of long-bone fractures. The severity of FES can vary from subclinical with mild respiratory changes and haematological aberrations to a fulminant state characterised by sudden onset of severe respiratory and neurological impairment. Here we present two patients with cerebral FES secondary to femur fracture. Both patients exhibited profound neurological impairment with varied outcomes. Our cases highlight the importance of a high clinical suspicion of FES in patients with long-bone fractures and neurological deterioration. We recommend early plate osteosynthesis to prevent additional emboli in patients with FES and situational placement of intracranial pressure monitoring. Finally, cerebral FES has low mortality even in a patient with tentorial herniation and fixed, dilated pupils.

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