Share This Article:

Cerebral Fat Embolism Syndrome from Penetrating Trauma: A Rare Cause-and-Effect

Full-Text HTML XML Download Download as PDF (Size:320KB) PP. 228-232
DOI: 10.4236/ojanes.2013.34052    4,389 Downloads   5,896 Views   Citations

ABSTRACT

A 42 year-old male sustained an accidental rifle gunshot wound to his left foot, resulting in fracture deformities of the calcaneus, navicular, cuneiform, 1st and 2nd metatarsal bases, and talus. As he was transported to our trauma center, he developed progressive encephalopathy. Urgent external fixator placement under general anesthesia was postponed due to his encephalopathy of unknown etiology. Brain magnetic resonance imaging demonstrated a “starfield” pattern of infarcts, consistent with cerebral fat embolism syndrome. Subsequently, he underwent uneventful general anesthesia. The patient was managed supportively and continued to have persistent neurologic dysfunction two months after injury.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

S. Gleich and J. Hannon, "Cerebral Fat Embolism Syndrome from Penetrating Trauma: A Rare Cause-and-Effect," Open Journal of Anesthesiology, Vol. 3 No. 4, 2013, pp. 228-232. doi: 10.4236/ojanes.2013.34052.

References

[1] E. A. Eriksson, D. C. Pellegrini, W. E. Vanderkolk, C. T. Minshall, S. M. Fakhry and S. D. Cohle, “Incidence of Pulmonary Fat Embolism at Autopsy: An Undiagnosed Epidemic,” Journal of Trauma, Vol. 71, No. 2, 2011, pp. 312-315. doi:10.1097/TA.0b013e3182208280
[2] A. R. Gurd, “Fat Embolism: An Aid to Diagnosis,” Journal of Bone and Joint Surgery, Vol. 52, No. 4, 1970, pp. 732-737.
[3] A. R. Gurd and R. I. Wilson, “The Fat Embolism Syndrome,” Journal of Bone and Joint Surgery, Vol. 56B, No. 3, 1974, pp. 409-416.
[4] S. Akhtar, “Fat Embolism,” Anesthesiology Clinics, Vol. 27, No. 3, 2009, pp. 533-550. doi:10.1016/j.anclin.2009.07.018
[5] A. Mellor and N. Soni, “Fat Embolism,” Anaesthesia, Vol. 56, No. 2, 2001, pp. 145-154. doi:10.1046/j.1365-2044.2001.01724.x
[6] C. W. Ryu, D. H. Lee, T. K. Kim, S. J. Kim, H. S. Kim, J. H. Lee, C. G. Choi and D. C. Suh, “Cerebral Fat Embolism: Diffusion-Weighted Magnetic Resonance Imaging Findings,” Acta Radiologica, Vol. 46, No. 5, 2005, pp. 528-533. doi:10.1080/02841850510021481
[7] A. Aravapalli, J. Fox and C. Lazaridis, “Cerebral Fat Embolism and the ‘Starfield’ Pattern: A Case Report,” Cases Journal, Vol. 2, No. 1, 2009, p. 212. doi:10.1186/1757-1626-2-212
[8] K. Taviloglu and H. Yanar, “Fat Embolism Syndrome,” Surgery Today, Vol. 37, No. 1, 2007, pp. 5-8. doi:10.1007/s00595-006-3307-5
[9] R. J. Byrick, J. B. Mullen, C. D. Mazer and C. B. Guest, “Transpulmonary Systemic Fat Embolism. Studies in Mongrel Dogs after Cemented Arthroplasty,” American Journal of Respiratory and Critical Care Medicine, Vol. 150, No. 5, 1994, pp. 1416-1422.
[10] F. Nastanski, W. I. Gordon and M. E. Lekawa, “Posttraumatic Paradoxical Fat Embolism to the Brain: A Case Report,” Journal of Trauma, Vol. 58, No. 2, 2005, pp. 372-374. doi:10.1097/01.TA.0000108996.10785.0B
[11] H. Satoh, K. Kurisu, M. Ohtani, K. Arita, S. Okabayashi, T. Nakahara, K. Migita, K. Iida, K. Kuroki and N. Ohbayashi, “Cerebral Fat Embolism Studied by Magnetic Resonance Imaging, Transcranial Doppler Sonography, and Single Photon Emission Computed Tomography: Case Report,” Journal of Trauma, Vol. 43, No. 2, 1997, pp. 345-348. doi:10.1097/00005373-199708000-00023
[12] M. E. Finlay and M. D. Benson, “Case Report: Magnetic Resonance Imaging in Cerebral Fat Embolism,” Clinical Radiology, Vol. 51, No. 6, 1996, pp. 445-446. doi:10.1016/S0009-9260(96)80169-3
[13] S. J. Pinney, J. F. Keating and R. N. Meek, “Fat Embolism Syndrome in Isolated Femoral Fractures: Does Timing of Nailing Influence Incidence?” Injury, Vol. 29, No. 2, 1998, pp. 131-133. doi:10.1016/S0020-1383(97)00154-X
[14] J. Kallenbach, M. Lewis, M. Zaltzman, C. Feldman, A. Orford and S. Zwi, “'Low-Dose Corticosteroid Prophylaxis against Fat Embolism,” Journal of Trauma, Vol. 27, No. 10, 1987, pp. 1173-1176. doi:10.1097/00005373-198710000-00013
[15] B. G. Lindeque, H. S. Schoeman, G. F. Dommisse, M. C. Boeyens and A. L. Vlok, “Fat Embolism and the Fat Embolism Syndrome. A Double-Blind Therapeutic Study,” Journal of Bone and Joint Surgery, Vol. 69, No. 1, 1987, pp. 128-131.
[16] R. J. Byrick, J. B. Mullen, P. Y. Wong, J. C. Kay, D. Wigglesworth and R. J. Doran, “Prostanoid Production and Pulmonary Hypertension after Fat Embolism Are Not Modified by Methylprednisolone,” Canadian Journal of Anaesthesia, Vol. 38, No. 5, 1991, pp. 660-667. doi:10.1007/BF03008205
[17] H. Chrysikopoulos, V. Maniatis, J. Pappas, P. Filalithis, C. Gogali and D. Sfyras, “Case Report: Post-Traumatic Cerebral Fat Embolism: CT and MR findings. Report of Two Cases and Review of the Literature,” Clinical Radiology, Vol. 51, No. 10, 1996, pp. 728-732. doi:10.1016/S0009-9260(96)80248-0
[18] M. Scopa, M. Magatti and P. Rossitto, “Neurologic Symptoms in Fat Embolism Syndrome: Case Report,” Journal of Trauma, Vol. 36, No. 6, 1994, pp. 906-908. doi:10.1097/00005373-199406000-00030
[19] G. Manousakis, D. Y. Han and M. Backonja, “Cognitive Outcome of Cerebral Fat Embolism,” Journal of Stroke and Cerebrovascular Diseases, Vol. 21, No. 8, 2012, pp. 1-3. http://www.ncbi.nlm.nih.gov/pubmed?term=Manousakis%20G%20Cognitive%20Outcome
[20] E. A. Eriksson, S. E. Schultz, S. D. Cohle and K. W. Post, “Cerebral Fat Embolism without Intracardiac Shunt: A Novel Presentation,” Journal of Emergencies, Trauma, and Shock, Vol. 4, No. 2, 2011, pp. 309-312. doi:10.4103/0974-2700.82233

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.