Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare case
Abstract Background Fat embolism syndrome (FES) is a rare complication that can occur between 12 and 72 h after the initial insult. Isolated cerebral FES without pulmonary symptoms is rarer. Early fracture fixation might prevent FES. We report a case of multiple-fracture with FES despite definite fi...
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12891-019-2736-4 |
| _version_ | 1818317814100918272 |
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| author | Chin-Kai Huang Chih-Yuan Huang Chia-Lung Li Jui-Ming Yang Chin-Hsien Wu Chih-Hui Chen Po-Ting Wu |
| author_facet | Chin-Kai Huang Chih-Yuan Huang Chia-Lung Li Jui-Ming Yang Chin-Hsien Wu Chih-Hui Chen Po-Ting Wu |
| author_sort | Chin-Kai Huang |
| collection | DOAJ |
| description | Abstract Background Fat embolism syndrome (FES) is a rare complication that can occur between 12 and 72 h after the initial insult. Isolated cerebral FES without pulmonary symptoms is rarer. Early fracture fixation might prevent FES. We report a case of multiple-fracture with FES despite definite fixation three hours post-injury. Case presentation A 54-year-old man presented with multiple fractures: left femoral shaft (AO B2), left distal radius (AO C3), left comminuted patella, right comminuted 1st metatarsal base and left 2nd-4th metatarsal neck. Because he was stable, we gave him early total care and definite fixation, which required seven hours and yielded no complications. After he recovered from anesthesia, however, his eyes deviated right, his right upper arm was paralyzed, his consciousness level was poor, and his Glasgow Coma Scale score was E3VeM4. Chest X-rays showed clear lung fields, and brain computed tomography showed no intracranial hemorrhage. He did, however, have tachycardia, anemia, and thrombocytopenia. Brain magnetic resonance images showed a hyperintensive starfield pattern on diffuse weighted images, which suggested cerebral FES. After supportive care, his consciousness cleared on postoperative day 17, and he recovered full right upper arm muscle power after four months; however, he had a significant cognitive deficit. One-year post-injury, after regular rehabilitation therapy, he was able to independently perform his activities of daily living but still had a residual mild cognitive deficit. Conclusion Early fixation can attenuate but not eliminate the incidence of FES. Early assessment and rehabilitation therapy might be required for patients with cerebral FES and cognitive deficits; however, such deficits are difficult to predict and need long-term follow-ups. |
| first_indexed | 2024-12-13T09:43:18Z |
| format | Article |
| id | doaj.art-d57d4f11a7f9407da8c6f61716c7dd2b |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-13T09:43:18Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-d57d4f11a7f9407da8c6f61716c7dd2b2022-12-21T23:52:08ZengBMCBMC Musculoskeletal Disorders1471-24742019-08-012011410.1186/s12891-019-2736-4Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare caseChin-Kai Huang0Chih-Yuan Huang1Chia-Lung Li2Jui-Ming Yang3Chin-Hsien Wu4Chih-Hui Chen5Po-Ting Wu6Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityDepartment of Orthopedics, Tainan ShinLau Christian HospitalDepartment of Orthopedics, E-Da Hospital/I-Shou UniversityDepartment of Orthopedics, Taichung Veterans General HospitalDepartment of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityAbstract Background Fat embolism syndrome (FES) is a rare complication that can occur between 12 and 72 h after the initial insult. Isolated cerebral FES without pulmonary symptoms is rarer. Early fracture fixation might prevent FES. We report a case of multiple-fracture with FES despite definite fixation three hours post-injury. Case presentation A 54-year-old man presented with multiple fractures: left femoral shaft (AO B2), left distal radius (AO C3), left comminuted patella, right comminuted 1st metatarsal base and left 2nd-4th metatarsal neck. Because he was stable, we gave him early total care and definite fixation, which required seven hours and yielded no complications. After he recovered from anesthesia, however, his eyes deviated right, his right upper arm was paralyzed, his consciousness level was poor, and his Glasgow Coma Scale score was E3VeM4. Chest X-rays showed clear lung fields, and brain computed tomography showed no intracranial hemorrhage. He did, however, have tachycardia, anemia, and thrombocytopenia. Brain magnetic resonance images showed a hyperintensive starfield pattern on diffuse weighted images, which suggested cerebral FES. After supportive care, his consciousness cleared on postoperative day 17, and he recovered full right upper arm muscle power after four months; however, he had a significant cognitive deficit. One-year post-injury, after regular rehabilitation therapy, he was able to independently perform his activities of daily living but still had a residual mild cognitive deficit. Conclusion Early fixation can attenuate but not eliminate the incidence of FES. Early assessment and rehabilitation therapy might be required for patients with cerebral FES and cognitive deficits; however, such deficits are difficult to predict and need long-term follow-ups.http://link.springer.com/article/10.1186/s12891-019-2736-4Cerebral fat embolism syndromeCognitive deficitLong-bone fractureOutcome |
| spellingShingle | Chin-Kai Huang Chih-Yuan Huang Chia-Lung Li Jui-Ming Yang Chin-Hsien Wu Chih-Hui Chen Po-Ting Wu Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare case BMC Musculoskeletal Disorders Cerebral fat embolism syndrome Cognitive deficit Long-bone fracture Outcome |
| title | Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare case |
| title_full | Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare case |
| title_fullStr | Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare case |
| title_full_unstemmed | Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare case |
| title_short | Isolated and early-onset cerebral fat embolism syndrome in a multiply injured patient: a rare case |
| title_sort | isolated and early onset cerebral fat embolism syndrome in a multiply injured patient a rare case |
| topic | Cerebral fat embolism syndrome Cognitive deficit Long-bone fracture Outcome |
| url | http://link.springer.com/article/10.1186/s12891-019-2736-4 |
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