Subject(s)
Embolism, Fat/psychology , Humeral Fractures/complications , Mental Disorders/etiology , Tibial Fractures/complications , Accidents, Traffic , Axilla , Embolism, Fat/etiology , Embolism, Fat/physiopathology , Humans , Male , Mental Disorders/diagnosis , Multiple Trauma/complications , Purpura/etiology , Respiration Disorders/etiology , Retinal Diseases/etiology , Syndrome , Tibial Fractures/surgery , Young AdultABSTRACT
OBJECTIVE: To describe a case of a young man with delayed coma after mild head injury, suggestive of cerebral fat embolism (CFE). To underline the value of MR imaging in the differential diagnosis of secondary deterioration in mild head injury. CASE REPORT: A 21-year-old man admitted with mild head injury after a fall with facial fractures and long bone fractures. He was admitted to the intensive care unit and was mechanically ventilated. Weaning was not possible because of desaturations and pulmonary congestion. Low platelet count and anaemia developed. On several time points during his admission cerebral imaging data were obtained. Non-contrast CT on admission was normal while follow-up MRI showed extensive white matter abnormalities. These imaging abnormalities combined with the clinical presentation suggests cerebral fat embolism (CFE) as the most likely cause of secondary deterioration in our patient. CONCLUSIONS: In head injured patients with long bone fractures one should consider cerebral fat embolism. When the classical clinical syndrome is not present, MR imaging is warranted for diagnosis and to exclude other causes of secondary deterioration.
Subject(s)
Coma/etiology , Craniocerebral Trauma/complications , Embolism, Fat/complications , Intracranial Embolism/complications , Adult , Brain Edema/diagnostic imaging , Brain Edema/pathology , Cognition Disorders/etiology , Cognition Disorders/psychology , Coma/psychology , Craniocerebral Trauma/psychology , Embolism, Fat/diagnosis , Embolism, Fat/psychology , Fractures, Bone/complications , Glasgow Coma Scale , Humans , Intracranial Embolism/diagnosis , Intracranial Embolism/psychology , Magnetic Resonance Angiography , Male , Respiration, Artificial , Tomography, X-Ray Computed , Young AdultABSTRACT
Fat embolism syndrome is associated with respiratory failure, hypoxia, petechial rash, pyrexia and altered mental state. Signs and symptoms usually begin within 12-72 h after trauma. The pathophysiology, differential diagnosis and therapeutic options of fat embolism syndrome are described and the case of a 29-year-old motorcyclist with fractures of the lower extremities, coma and respiratory failure 24-36 h after an accident is reported. Based on the clinical signs and course, fat embolism syndrome was suspected which was substantiated by ophthalmic fundoscopy and magnetic resonance imaging of the head.
Subject(s)
Coma/etiology , Embolism, Fat/diagnosis , Embolism, Fat/etiology , Multiple Trauma/complications , Respiratory Insufficiency/etiology , Accidents, Traffic , Adult , Coma/psychology , Diagnosis, Differential , Embolism, Fat/psychology , Fractures, Bone/complications , Fundus Oculi , Humans , Magnetic Resonance Imaging , Male , Motorcycles , Multiple Trauma/psychology , Ophthalmoscopy , Respiratory Insufficiency/psychologyABSTRACT
BACKGROUND AND PURPOSE: Intra-operative cerebral microembolism may be a factor in the etiology of cognitive decline after orthopedic surgery. We here examine the impact of intra-operative microembolism on cognitive dysfunction after hip and knee replacement surgery. METHODS: We enrolled 24 patients, at least 65 years old, requiring elective knee or hip replacement surgery. A transcranial Doppler shunt study was done to determine study eligibility so that the final study population consisted of 12 consecutive patients with and 12 consecutive patients without a venous-arterial shunt. A standard neuropsychological test battery was administered before surgery, at hospital discharge and 3 months after surgery. All patients were monitored intra-operatively for microemboli. Quality of life data were assessed at 1 year. RESULTS: The mean age of patients was 74 years. All patients had intra-operative microemboli. The mean number of emboli was 9.9+/-18. Cognitive decline was present in 18/22 (75%) at discharge and in 10/22 (45%) at 3 months, despite improved quality of life measures. There was no correlation between cognitive decline and intra-operative microembolism. CONCLUSIONS: Cognitive decline was seen frequently after hip and knee surgery. Intra-operative microembolism occurred universally but did not significantly influence postoperative cognition. Quality of life and functional outcome demonstrated improvement in all cases in spite of cognitive dysfunction.
