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A Case Report of Cerebral Fat Embolism
Syndrome In a Trauma Patient Without Cardiac Abnormality
R.S. LaButti, D.O. and Steven D. Jones, D.O.
Oklahoma State University College of Osteopathic Medicine -
Tulsa Regional Medical Center
Abstract
| Cerebral fat embolism syndrome is a
documented, if not rare, complication following long bone
fractures, fixation of long-bone fractures, and total joint
arthroplasty. An 18 year-old female developed clinical signs
of cerebral fat embolism syndrome following closed reduction
of a hip dislocation and closed intermedullary rodding of an
ipsilateral mid-shaft femur fracture. Immediately
post-operatively the patient was obtunded and required
ventilatory support. An initial MRI of the brain revealed
characteristic diffuse cerebral and cerebellar infarcts. An
echocardiogram was obtained and showed no evidence of
cardiac abnormality, left-to-right shunt, or patent foramen
ovale. The patient progressively improved throughout her
hospital stay and regained full cognition prior to
discharge. A second MRI, performed twenty-one days after the
inital study, demonstrated marked improvement in the
cerebral lesions and complete resolution of the cerebellar
lesions. This is a unique case of paradoxical cerebral fat
embolism following intramedullary rodding of the femur in
the absence of cardiac abnormalities causing a left-to-right
shunt, such as a patent foramen ovale. |
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Figures 1a and 1b:
Initial Emergency Room
radiographs depicting inferior
hip dislocation and ipsilateral
femoral shaft fracture. |
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Figures 2a and 2b:
Pre-reduction CT of the hip joint
showing inferior hip dislocation. |
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Figure 3:
Post-operative radiograph
of the femur with antegrade
intramedullary rod. |
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Figure 4:
Post-reduction CT of the
hip joint demonstrating the
femoral head reduced
within the acetabulum. |
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Figures 5a, 5b, and 5c:
Initial MRI exam of the brain
showing diffuse cerebral (5a and 5b -
upper left and right) and cerebellar (5c - left)
infarcts secondary to Fat Embolism Syndrome.
This study was performed
post-operatively after the patient
became obtunded. |
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Figures 6a, 6b, and 6c:
Follow-up MRI exam of the brain showing
marked improvement of the cerebral
lesions (6a and 6b - upper left and right) and
complete resolution of the cerebellar lesions (6c - right).
This was performed 21 days after the initial MRI,
and after the patient's clinical symptoms had
subsided. |
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Figures 7a, 7b, and 7c:
Echocardiogram images
demonstrating normal cardiac
anatomy and no left-to-right
shunt. |
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