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[Post-traumatic cerebral fat embolism].

M Thicoïpe1, M André, P Maurette

  • 1Service de Réanimation Traumatologique et Post-Chirurgicale, Hôpital Pellegrin, Bordeaux.

Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1988
PubMed
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A severe road traffic accident led to fractures and cerebral fat embolism in a teenager. Despite initial coma and brain swelling, the patient showed significant clinical recovery, though MRI revealed lasting brain lesions.

Area of Science:

  • Neurology
  • Trauma Surgery
  • Radiology

Background:

  • Road traffic accidents can cause severe fractures and life-threatening complications.
  • Cerebral fat embolism syndrome (CFES) is a rare but serious consequence of long bone fractures.

Observation:

  • A 17-year-old male sustained pelvic, femoral, and malleolar fractures after a road traffic accident.
  • He developed coma (Glasgow Coma Scale 7, worsening to 4), petechiae, and diffuse brain swelling, diagnosed as cerebral fat embolism.
  • Multiple episodes of intracranial hypertension were managed, with femoral fracture fixation after 23 days of traction.

Findings:

  • The patient experienced significant clinical improvement, returning home after five months with minor memory and writing difficulties.
  • Ten months post-accident, MRI revealed ventricular dilatation, subcortical atrophy, and residual ischemic lesions with demyelination in the centrum ovale and temporal lobe.

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  • These neuroimaging findings contrasted with the patient's substantial clinical recovery.

    • Implications:

    • This case highlights the potential for significant neurological recovery despite severe cerebral fat embolism and associated brain lesions.
    • It underscores the importance of prompt diagnosis and management of intracranial hypertension in CFES.
    • The findings suggest that neuroimaging may not always correlate directly with long-term clinical outcomes in traumatic brain injury and fat embolism.