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Initial right common carotid angiogram demonstrating abrupt cutoff of the right internal carotid artery just distal to the bifurcation.
Source publication
Background:
The classic triad of fat embolism syndrome consists of pulmonary distress, mental status change, and petechial rash. Typically, symptoms manifest 24-48 hours after a long bone fracture, but case reports have demonstrated fat embolism syndrome without long bone fracture. These cases are initiated by a stress response, mobilizing free fa...
Context in source publication
Citations
... Delayed stabilization for femur fractures increases the incidence of acute respiratory distress syndrome (ARDS) and fat embolism (11). Metabolic stress triggers catecholamines release, activation of adenylyl cyclase pathway, lipase activation, hydrolyzing triglycerides into free fatty acids and glycerol which then enter the systemic circulation, and also microvascular obstruction free fatty acid mediated endothelial injury and excess thrombin, elevated tissue factor fibrin generation and consumption of coagulation product may lead to ARDS, encephalopathy, and focal neurological deficit, cutaneus ptechiae, DIC, thrombocytopenia, and anemia (2,12,13). Diabetes mellitus is a risk factor for fat embolism (14) and a hazard ratio of ischemic stroke of 2.27 times even with minimal impact on soft tissue (2,15). Hypertension also increases the risk of fat embolism formation (16). ...
Introduction and importance
Cerebral fat embolism syndrome is a rare complication of long bone fractures, often overlooked and found in late stages. We present patient with a late recognition of Cerebral Fat Embolism with Large vessel occlusion post femoral internal fixation.
Case presentation
An elderly female suffered right intertrochanteric fracture after falling down. Open reduction internal fixation with Interlocking plate was performed at the fifth day. Upon returning to the ward, the patient did not regain full consciousness and apparent right hemiparesis were observed. A head Computed Tomography was performed and found left hemisphere ischemia consistent with middle cerebral artery occlusion. The patient condition worsened and died 3 days postoperatively.
Clinical discussion
Cases of fat embolism that occur purely isolated in the brain are rare cases that occur after internal fixation of the femur, so they are often not noticed by clinicians. Several factors can increase the risk of the event, delay in fixation and diabetes mellitus which was found in our patient could increase the risk of fat emboli syndrome. Apart from that, osteoporosis also increases the risk of fat embolism syndrome that was found in our subject.
Conclusions
Cerebral Large Vessel Occlusion Fat Embolism Syndrome is rare case occur following internal fixation. There is a need for early recognition to be carried out to treat early or prevent the occurrence of fat embolism.
... It is recently reported that 95% of fat embolism are due to significant trauma [3]. Several non-traumatic situations are related to fat embolism as liposuction [4], bone marrow biopsy and transplant [4], video-assisted thoracoscopy [4], [5], pancreatitis and gastrectomy [6], [7], and massive soft tissue [7]. There is only one interesting paper in the literature that describes cerebral fat embolism in the absence of long bone fractures [6]. ...
... Several non-traumatic situations are related to fat embolism as liposuction [4], bone marrow biopsy and transplant [4], video-assisted thoracoscopy [4], [5], pancreatitis and gastrectomy [6], [7], and massive soft tissue [7]. There is only one interesting paper in the literature that describes cerebral fat embolism in the absence of long bone fractures [6]. Hence, our case according to literature would be a rare case that after minor soft-tissues trauma, fat embolism syndrome can be developed. ...
BACKGROUND: Fat embolism syndrome is a life challenge syndrome. Early diagnosing and treatment can significantly improve the patient’s prognosis and likelihood of success. This syndrome occurs mainly after long bones fractures or orthopedic surgery up to 95% of diagnosed cases, but in unusual situation can be faced as well. These rare situations include diabetes mellitus, video-assisted thoracoscopies, fatty liver, and fat injection in plastic and cosmetic procedures. The likelihood of this syndrome can be increased if multiplex long bones fractures occur in the same patient simultaneously. This syndrome is usually manifested with respiratory changes (hypoxemia and ARDS), neurological focal symptoms (confusion, headache, aphasia, and hemiplegia), and skin abnormalities (petechias, and rush in conjunctiva and oral mucosa). The clinical scenario begins typically after 24−72 h of injury, and mainly, respiratory changes are the first, followed by neurological abnormalities and finally petechias as the most significant sign. CASE REPORT: In this case, we report a rare case of unexpected fat embolism syndrome after soft-tissue minimal trauma. This is the first case that we faced according to literature, and the aim of reporting this case is to emphasize that fat syndrome embolism can happen perhaps in every trauma patient even in minor soft-tissue trauma in absence of bone fractures. CONCLUSION: We strongly suggest that this case should make the physicians taking in consideration fat embolism syndrome even if bone fracture missed, to early diagnosing and adequately treating the patient, and optimizing his chances to survive.
... Eight of the reported patients had undergone cardiac surgery, most commonly mitral valve replacement (6 patients) (11,(14)(15)(16)(17)(18)(19)(20). Six patients had orthopaedic procedures or preceding trauma, and three patients were deemed spontaneous (2,10,(21)(22)(23)(24)(25)(26)(27). Of the spontaneous cases, one patient had a history of liposuction and gluteal augmentation 2 months prior, but this was presumed unrelated (2). ...
... Distal contact aspiration alone (ADAPT) OR used in combination with stent retrievers would be a favoured first line approach. Of the 7 reported patients who underwent reperfusion therapy (ECR or STA-MCA bypass, excluding the patient who had unsuccessful ECR), 5 survived with reasonable function (modified Rankin scale 3 or better from case descriptions), one patient died due lack of clinical improvement, and another died due to intracranial haemorrhage shortly after ECR (2,14,(22)(23)(24)(25)(26). In comparison, of the patients who did not receive reperfusion therapy or received unsuccessful reperfusion therapy, five patients died, and two were functionally disabled (mRS 4) (10,15,17,18,21,27,28). ...
The diagnosis of fat embolism syndrome typically involves neurological, respiratory and dermatological manifestations of microvascular occlusion 24–72 h after a precipitating event. However, fat embolism causing cerebral large vessel occlusion strokes and their sequelae have rarely been reported in the literature. This case series reports three patients with fat emboli post operatively causing cerebral large vessel occlusions, as well as a review of the literature to identify differences in clinical presentations and outcomes in stroke secondary to fat emboli causing large vessel occlusions compared to those with fat embolism syndrome.
Introduction
fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations.
Methods
we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma.
Results
the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community.
Conclusion
to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.
Keywords:
Embolism, Fat; Respiratory Distress Syndrome; Postoperative Complications; Multiple Trauma; Wounds and Injuries
Fat embolism in non-orthopedic trauma patients
