J Yeungnam Med Sci.  2023 Apr;40(2):207-211. 10.12701/jyms.2022.00360.

Cerebral fat embolism syndrome: diagnostic challenges and catastrophic outcomes: a case series

• Algahtani HA
• Shirah BH
• Abdelghaffar N
• Alahmari F
• Alhadi W
• Alqahtani SA

• KMID: 2541949
• DOI: http://doi.org/10.12701/jyms.2022.00360

Abstract

Fat embolism syndrome is a rare but alarming, life-threatening clinical condition attributed to fat emboli entering the circulation. It usually occurs as a complication of long-bone fractures and joint reconstruction surgery. Neurological manifestations usually occur 12 to 72 hours after the initial insult. These neurological complications include cerebral infarction, spinal cord ischemia, hemorrhagic stroke, seizures, and coma. Other features include an acute confusional state, autonomic dysfunction, and retinal ischemia. In this case series, we describe three patients with fat embolism syndrome who presented with atypical symptoms and signs and with unusual neuroimaging findings. Cerebral fat embolism may occur without any respiratory or dermatological signs. In these cases, diagnosis is established after excluding other differential diagnoses. Neuroimaging using brain magnetic resonance imaging is of paramount importance in establishing a diagnosis. Aggressive hemodynamic and respiratory support from the beginning and consideration of orthopedic surgical intervention within the first 24 hours after trauma are critical to decreased morbidity and mortality.

Keyword

Brain; Fat embolism syndrome; Road traffic injury

Figure

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  Fig. 1. Brain magnetic resonance images show extensive bilateral, symmetrical punctate foci of nearly the same size and abnormal signal intensities affecting both cerebral and cerebellar hemispheres with diffusion restriction and decreased susceptibility-weighted imaging (microbleeds) and mottled fluid-attenuated inversion recovery signals. Arrows indicate one of the foci as an example.

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  Fig. 2. Brain magnetic resonance images show extensive small high-signal intensity lesions involving the whole brain giving the appearance of a starfield pattern on T2-weighted images with restricted diffusion and profuse microhemorrhages in susceptibility-weighted imaging. Arrows indicate one of the lesions as an example.

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  Fig. 3. Brain magnetic resonance images show innumerable deep-white-matter, high-signal foci on T2-weighted images and low-signal foci on T1-weighted images showing restricted diffusion on diffusion-weighted imaging. Some images show blooming artifacts on susceptibility-weighted imaging consistent with multiple small infarctions and some show hemorrhagic components consistent with fat embolism. Arrows indicate one of the foci as an example.

Reference

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