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Published on: November 9, 2018
Delayed coma in head injury: consider cerebral fat embolism
Zwany Metting1, Lars A Rödiger, Joost G Regtien
1Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands. z.metting@neuro.umcg.nl
Clinical Neurology and Neurosurgery
|April 28, 2009
Summary
Delayed coma after mild head injury may indicate cerebral fat embolism (CFE). Magnetic resonance (MR) imaging is crucial for diagnosing CFE in head-injured patients with fractures, especially when typical symptoms are absent.
Area of Science:
- Neurology
- Radiology
- Trauma Surgery
Background:
- Mild head injury can lead to delayed neurological deterioration.
- Long bone and facial fractures are common in trauma patients.
- Cerebral fat embolism (CFE) is a potential complication of fractures.
Observation:
- A 21-year-old male presented with mild head injury, facial, and long bone fractures.
- Initial CT scan was normal; however, subsequent MRI revealed extensive white matter abnormalities.
- The patient experienced delayed coma, respiratory distress, and hematological changes.
Findings:
- The clinical presentation and MRI findings were highly suggestive of cerebral fat embolism (CFE).
- MR imaging proved invaluable in identifying white matter lesions consistent with CFE.
- CFE was identified as the likely cause of secondary deterioration.
Implications:
- Clinicians should consider CFE in head-injured patients with long bone fractures, particularly those with delayed neurological decline.
- MR imaging is essential for diagnosing CFE when the classic clinical syndrome is not apparent.
- Early diagnosis and intervention for CFE can improve patient outcomes in traumatic brain injury.
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