Abstract
Purpose
To describe cardiovascular collapse during a cemented hip hemiarthroplasty in a patient who, despite a successful cardiopulmonary resuscitation, remained in a persistent vegetative state due to cerebral fat embolism diagnosed by magnetic resonance imaging (MRI).
Clinical features
A 75-yr-old woman with no medical history underwent cemented hip hemiarthroplasty under spinal anesthesia for a right femoral neck fracture. Shortly after insertion of the prosthesis, a sudden oxygen desaturation, hypotension, bradycardia, and cardiac arrest occurred. The patient was successfully resuscitated, but did not regain consciousness. The patient developed highgrade fever, thrombocytopenia, anemia, and oliguria. MRI scans of the brain revealed multiple high intensity signals throughout the white matter, the basal ganglia, the cerebellum, and the brain stem. The diagnosis of fat embolism was made on the basis of clinical findings and MRI images. Although her cardiorespiratory status improved over the next week, the patient remained in a persistent vegetative state.
Conclusion
When fat embolism is suspected, serial MRI scans of the brain should be performed to diagnose the etiology of cerebral embolism as well as to evaluate the severity of brain damage.
Résumé
Objectif
Décrire le collapsus cardiovasculaire survenu pendant une hémi-arthroplastie de la hanche chez une patiente qui, malgré une réanimation cardiopulmonaire réussie, est demeurée dans un état végétatif persistant à cause d’une embolie graisseuse diagnostiquée grâce à l’imagerie par résonance magnétique.
Éléments cliniques
Une femme de 75 ans, sans antécédents médicaux, a subi une hémi-arthroplastie cimentée de la hanche sous rachianesthésie à la suite d’une fracture du col du fémur. Peu après l’insertion de la prothèse, il y a eu l’apparition soudaine de désaturation en oxygène, d’hypotension, de bradycardie et un arrêt cardiaque. La patiente, réanimée avec succès, n’a pourtant pas repris conscience. Une forte fièvre, une thrombocytopénie, de l’anémie et de l’oligurie se sont développées. L’IRM du cerveau a révélé de multiples signaux de haute intensité dans la matière blanche, les noyaux gris centraux, le cervelet et le tronc cérébral. Les constatations cliniques et les images d’IRM ont conduit au diagnostic d’embolie graisseuse. Même si l’état cardiorespiratoire s’est amélioré au cours de la semaine suivante, la patiente est demeurée dans un état végétatif persistant.
Conclusion
En cas d’embolie graisseuse présumée, une série d’examens d’IRM du cerveau devraient être faits pour découvrir la cause de l’embolie et évaluer la sévérité de la lésion.
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Sasano, N., Ishida, S., Tetsu, S. et al. Cerebral fat embolism diagnosed by magnetic resonance imaging at one, eight, and 50 days after hip arthroplasty: a case report. Can J Anesth 51, 875–879 (2004). https://doi.org/10.1007/BF03018883
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DOI: https://doi.org/10.1007/BF03018883