Neuroimaging findings in a case of cerebral fat embolism syndrome with delayed recovery
Shveta Kajal, Anupriya Saxena
Keywords :
Cerebral, fat embolism syndrome, intensive care, magnetic resonance imaging, neurological
Citation Information :
Kajal S, Saxena A. Neuroimaging findings in a case of cerebral fat embolism syndrome with delayed recovery. Indian J Crit Care Med 2015; 19 (11):674-677.
A young male with multiple lower limb fractures admitted to our Intensive Care Unit was diagnosed with cerebral fat embolism syndrome (FES) based on clinical features and initial magnetic resonance imaging (MRI) which showed multiple hyperintensities on T2-weighted imaging, involving bilateral cerebral and cerebellar hemispheres, predominantly in the watershed territory. The serial MRI done at 3 weeks showed more prominent and larger sized lesions which were in line with the patient′s initial low Glasgow Coma Score and indicated severe cerebral insult. The patient responded well to supportive intensive care therapy; his neurological recovery though slow was consistent as he could return to his full functional status after 6 months. The follow-up MRI showed resolution of the most of earlier lesions. This indicates potentially good outcomes even in severe cases of cerebral FES with appropriate medical care.
Müller C, Rahn BA, Pfister U, Meinig RP. The incidence, pathogenesis, diagnosis, and treatment of fat embolism. Orthop Rev 1994;23:107-17.
Stein PD, Yaekoub AY, Matta F, Kleerekoper M. Fat embolism syndrome. Am J Med Sci 2008;336:472-7.
Meyer N, Pennington WT, Dewitt D, Schmeling GJ. Isolated cerebral fat emboli syndrome in multiply injured patients: A review of three cases and the literature. J Trauma 2007;63:1395-402.
Jacobson DM, Terrence CF, Reinmuth OM. The neurologic manifestations of fat embolism. Neurology 1986;36:847-51.
Butteriss DJ, Mahad D, Soh C, Wall T, Weir D, Birchall D. Reversal cytotoxic cerebral edema in cerebral fat embolism. Am J Neuroradiol 2003;24:97-101.
Marshall GB, Heale VR, Herx L, Abdeen A, Mrkonjic L, Powell J, et al. Magnetic resonance diffusion weighted imaging in cerebral fat embolism. Can J Neurol Sci 2004;31:417-21.
Brant-Zawadzki M, Atkinson D, Detrick M, Bradley WG, Scidmore G. Fluid-attenuated inversion recovery (FLAIR) for assessment of cerebral infarction. Initial clinical experience in 50 patients. Stroke 1996;27:1187-91.
Parizel PM, Demey HE, Veeckmans G, Verstreken F, Cras P, Jorens PG, et al. Early diagnosis of cerebral fat embolism syndrome by diffusion-weighted MRI (starfield pattern). Stroke 2001;32:2942-4.
Kim HJ, Lee CH, Lee SH, Moon TY. Magnetic resonance imaging and histologic findings of experimental cerebral fat embolism. Invest Radiol 2003;38:625-34.
Takahashi M, Suzuki R, Osakabe Y, Asai JI, Miyo T, Nagashima G, et al. Magnetic resonance imaging findings in cerebral fat embolism: Correlation with clinical manifestations. J Trauma 1999;46:324-7.
Gregorakos L, Sakayianni K, Hroni D, Harizopoulou V, Markou N, Georgiadou F, et al. Prolonged coma due to cerebral fat embolism: Report of two cases. J Accid Emerg Med 2000;17:144-6.