Abstract
Fat embolism syndrome (FES) is an uncommon but serious complication of traumatic injury and is frequently diagnostically challenging. In this paper, the authors present four patients who sustained lower extremity long bone injury and who had a normal Glasgow Coma Scale before orthopedic surgical intervention. However, postoperatively, significant neurological deterioration developed in these patients. While cranial computed tomography (CT) obtained immediately after surgery for acutely altered mental status was negative in two of the four patients, brain magnetic resonance imaging (MRI) demonstrated white and gray matter abnormalities accounting for the impaired neurological status in all cases. MRI findings in conjunction with clinical presentation established the diagnosis in all patients. MRI is indicated in any patient with orthopedic injuries who manifests an unexplained acute alteration in mental status, despite a normal head CT.
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Ereth MH, Weber JG, Abel MD et al (1992) Cemented versus noncemented total hip arthroplasty—embolism, hemodynamics, and intrapulmonary shunting. Mayo Clin Proc 67(11):1066–1074
Schemitsch EH, Turchin DC, Anderson GI, Byrick RJ, Mullen JB, Richards RR (1998) Pulmonary and systemic fat embolization after medullary canal pressurization: a hemodynamic and histologic investigation in the dog. J Trauma 45(4):738–742
Bulger EM, Smith DG, Maier RV, Jurkovich GJ (1997) Fat embolism syndrome. A 10-year review. Arch Surg 132(4):435–439
Johnson MJ, Lucas GL (1996) Fat embolism syndrome. Orthopedics 19(1):41–48 discussion 8–9)
Kim HJ, Lee CH, Lee SH, Moon TY (2003) Magnetic resonance imaging and histologic findings of experimental cerebral fat embolism. Invest Radiol 38(10):625–634
Citerio G, Bianchini E, Beretta L (1995) Magnetic resonance imaging of cerebral fat embolism: a case report. Intensive Care Med 21(8):679–681
Satoh H, Kurisu K, Ohtani M et al (1997) Cerebral fat embolism studied by magnetic resonance imaging, transcranial Doppler sonography, and single photon emission computed tomography: case report. J Trauma 43(2):345–348
Stoeger A, Daniaux M, Felber S, Stockhammer G, Aichner F, zur Nedden D (1998) MRI findings in cerebral fat embolism. Eur Radiol 8(9):1590–1593
Glover P, Worthley LI (1999) Fat embolism. Crit Care Resusc 1(3):276–284
Byrick RJ, Korley RE, McKee MD, Schemitsch EH (2001) Prolonged coma after unreamed, locked nailing of femoral shaft fracture. Anesthesiology 94(1):163–165
Wenda K, Runkel M, Degreif J, Ritter G (1993) Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing—demonstrated by intraoperative echocardiography. Injury 24(Suppl 3):S73–S81
Dudney TM, Elliott CG (1994) Pulmonary embolism from amniotic fluid, fat, and air. Prog Cardiovasc Dis 36(6):447–474
Levy D (1990) The fat embolism syndrome. A review. Clin Orthop Relat Res 261:281–286
Bokhari SI, Alpert JS (2003) Probable acute coronary syndrome secondary to fat embolism. Cardiol Rev 11(3):156–159
Gossling HR, Donohue TA (1979) The fat embolism syndrome. JAMA 241(25):2740–2742
Habashi NM, Andrews PL, Scalea TM (2006) Therapeutic aspects of fat embolism syndrome. Injury 37(Suppl 4):S68–S73
Hofmann S, Huemer G, Salzer M (1998) Pathophysiology and management of the fat embolism syndrome. Anaesthesia 53(Suppl 2):35–37
Nakata Y, Tanaka H, Kuwagata Y, Yoshioka T, Sugimoto H (1999) Triolein-induced pulmonary embolization and increased microvascular permeability in isolated perfused rat lungs. J Trauma 47(1):111–119
Drew PA, Smith E, Thomas PD (1998) Fat distribution and changes in the blood brain barrier in a rat model of cerebral arterial fat embolism. J Neurol Sci 156(2):138–143
Gossling HR, Pellegrini VD Jr (1982) Fat embolism syndrome: a review of the pathophysiology and physiological basis of treatment. Clin Orthop Relat Res 165:68–82
Kim HJ, Lee CH, Lee SH et al (2001) Early development of vasogenic edema in experimental cerebral fat embolism in cats: correlation with MRI and electron microscopic findings. Invest Radiol 36(8):460–469
Oh WH, Mital MA (1978) Fat embolism: current concepts of pathogenesis, diagnosis, and treatment. Orthop Clin North Am 9(3):769–779
Bardana D, Rudan J, Cervenko F, Smith R (1998) Fat embolism syndrome in a patient demonstrating only neurologic symptoms. Can J Surg 41(5):398–402
Finlay ME, Benson MD (1996) Case report: magnetic resonance imaging in cerebral fat embolism. Clin Radiol 51(6):445–446
Kawano Y, Ochi M, Hayashi K, Morikawa M, Kimura S (1991) Magnetic resonance imaging of cerebral fat embolism. Neuroradiology 33(1):72–74
Nastanski F, Gordon WI, Lekawa ME (2005) Posttraumatic paradoxical fat embolism to the brain: a case report. J Trauma 58(2):372–374
Butteriss DJA, Mahad D, Soh C et al (2006) Reversible cytotoxic cerebral edema in cerebral fat embolism. AJNR 27:620–623
Takahashi M, Suzuki R, Osakabe Y et al (1999) Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations. J Trauma 46(2):324–327
Chrysikopoulos H, Maniatis V, Pappas J, Filalithis P, Gogali C, Sfyras D (1996) Case report: post-traumatic cerebral fat embolism: CT and MR findings. Report of two cases and review of the literature. Clin Radiol 51(10):728–732
Sakamoto T, Sawada Y, Yukioka T, Yoshioka T, Sugimoto T, Taneda M (1983) Computed tomography for diagnosis and assessment of cerebral fat embolism. Neuroradiology 24(5):283–285
Ryu CW, Lee DH, Kim TK et al (2005) Cerebral fat embolism: diffusion-weighted magnetic resonance imaging findings. Acta Radiol 46(5):528–533
Simon AD, Ulmer JL, Strottmann JM (2003) Contrast-enhanced MR imaging of cerebral fat embolism: case report and review of the literature. AJNR 24(1):97–101
Eguia P, Medina A, Garcia-Monco JC, Martin V, Monton FI (2007) The value of diffusion-weighted MRI in the diagnosis of cerebral fat embolism. J Neuroimaging 17(1):78–80
Parizel PM, Demey HE, Veeckmans G et al (2001) Early diagnosis of cerebral fat embolism syndrome by diffusion-weighted MRI (starfield pattern). Stroke 32(12):2942–2944
Sasano N, Susumu I, Shinichiro T et al (2004) Cerebral fat embolism diagnosed by magnetic resonance imaging at one, eight, and 50 days after hip arthroplasty: a case report. Can J Anaesth 51:875–879
Malagari K, Economopoulos N, Stoupis C et al (2003) High-resolution CT findings in mild pulmonary fat embolism. Chest 123:1196–1201
Pinney SJ, Keating JF, Meek RN (1998) Fat embolism syndrome in isolated femoral fractures: does timing of nailing influence incidence. Injury 29:131–133
Pollak R, Myers RA (1978) Early diagnosis of the fat embolism syndrome. J Trauma 18:121–123
Hagan IG, Burney K (2007) Radiology of recreation drug use. Radiographics 27:919–940
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Chen, J.JS., Ha, J.C. & Mirvis, S.E. MR imaging of the brain in fat embolism syndrome. Emerg Radiol 15, 187–192 (2008). https://doi.org/10.1007/s10140-007-0664-3
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DOI: https://doi.org/10.1007/s10140-007-0664-3