Cerebral fat embolism syndrome at a single trauma center |
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| Institution: | 1. Department of Neurology, University of Florida, Gainesville, FL, United States;2. Department of Neurology, Harborview Medical Center, University of Washington School of Medicine, Box 359775, 325 Ninth Avenue, Seattle, WA 98104, United States;3. Department of Biostatistics, University of Washington, Seattle, WA, United States;4. Department of Radiology, University of North Carolina, Chapel Hill, NC, United States;5. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada;1. Swedish Medical Center, Englewood, CO, United States;2. Injury Outcomes Network and Trauma Research, LLC, 501 E Hampden Ave, Englewood, CO 80113, United States;1. Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;2. University of California, San Francisco, CA, USA;3. College of Medicine, University of Ibadan, Ibadan, Nigeria;4. University of Ghana Medical School, Accra, Ghana;5. University of Ilorin Teaching Hospital, Nigeria;6. Ahmadu Bello University, Zaria, Nigeria;7. Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria;8. Aminu Kano Teaching Hospital, Nigeria;9. Delta State University Teaching Hospital, Ogara, Nigeria;10. Medical University of South Carolina, SC, USA;11. University of Kentucky, USA;12. University of Alabama at Birmingham, Birmingham, USA;13. Federal Medical Centre, Abeokuta, Nigeria;1. Centro Integral de Neurología Vascular, Fleni. Ciudad Autónoma de Buenos Aires, Argentina;2. Centro de Rehabilitación de Adultos – CR Escobar, Fleni. Buenos Aires, Argentina;3. Centro Integral de Epilepsia y Unidad de Video EEG, Fleni. Ciudad Autónoma de Buenos Aires, Argentina;4. Servicio de Diagnóstico por Imágenes, Fleni. Ciudad Autónoma de Buenos Aires, Argentina;1. Department of Neurosurgery, Nakamura Memorial South Hospital, Hokkaido, Japan;2. Department of Neurosurgery, Nakamura Memorial Hospital, Hokkaido, Japan;1. Neurology and Stroke Unit, AORN “A. Cardarelli”, Naples, Italy;2. Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy;3. Internal Medicine and Immunology, Federico II University, Naples |
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| Abstract: | ObjectivesBased on a 16-year case series, we sought lessons about diagnosis and treatment of cerebral fat embolism syndrome.Materials and methodsUsing discharge codes at a Level 1 Trauma Center, we performed a retrospective chart review of clinical characteristics, diagnostic studies, treatments, and outcome in cerebral fat embolism syndrome.ResultsThirty-nine (40%) of 97 patients with fat embolism syndrome were diagnosed with cerebral fat embolism syndrome, with 29 (74%) presenting with coma. All had abnormal brain magnetic resonance imaging, with scattered cytotoxic edema (starfield pattern) in 29 (74%). All but two of the 21 patients with dilated fundoscopy showed retinal embolism. Among 29 patients with transcranial Doppler, the presence of microembolic signals in 15 (52%) was associated with fever (p = 0.039), right-to-left intracardiac shunting (p = 0.046) and a trend towards initial coma. In 11 patients with serial transcranial Dopplers and treatment with high-intensity statin therapy, the frequency of microembolic signals tended to decrease after therapy was initiated. Of the 28 (72%) of the 39 patients discharged, 16 (57%) had mild to moderate disability at last follow up.ConclusionsThe recognition of cerebral fat embolism syndrome may be improved with routine inclusion of brain magnetic resonance imaging, dilated fundoscopy, and transcranial Doppler. We share our empiric management algorithm for cerebral fat embolism syndrome using these studies and with consideration of experimental therapies in select patients to prevent ongoing cerebral injury. |
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