• Journal of Trauma and Injury
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• v.34 no.2
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• pp.126-129
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• 2021

Fat embolism syndrome is a rare, but serious condition that occurs in patients with fractures of the long bones or who undergo orthopedic surgery. The main clinical features of fat embolism syndrome are an altered mental status, hypoxia, and petechial rash. Cerebral fat embolism is the most severe manifestation of fat embolism syndrome because it can lead to an altered mental status. The diagnosis of cerebral fat embolism is clinical, but brain magnetic resonance image (MRI) is helpful. There is usually an interval until symptoms, such as an altered mental status, develop after trauma. We report a case of cerebral fat embolism in which the patient's mental status deteriorated several hours after trauma and the initial findings were negative on diffusion-weighted MRI.

• Journal of Trauma and Injury
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• v.26 no.2
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• pp.58-62
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• 2013

A cerebral fat embolism is an uncommon but serious complication of long bone fracture. It can be fatal, and early detection is not easy. Neurologic symptoms are variable, and the clinical diagnosis is difficult. The pathogenesis remains controversial, and several theories have been proposed. Magnetic resonance imaging can detect a cerebral fat embolism with a higher sensitivity than cerebral computed tomography. We report a case of a posttraumatic cerebral fat embolism without pulmonary involvement and review the existing literature.

• Journal of Trauma and Injury
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• v.18 no.2
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• pp.175-178
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• 2005

Fat embolism syndrome is a collection of respiratory, neurological and cutaneous symptoms and signs associated with trauma and other disparate surgical and medical conditions. The incidence of clinical syndrome is low while the embolization of marrow fat appears to be an almost inevitable consequence of long bone fractures. The pathogenesis is a subject of conjecture and controversy. There are two theories which have gained acceptance(mechanical theory, biochemical theory). Onset of symptom is usually within 12 to 72 hours, but may manifest as early as 6 hours to as late as 10 days. The classic triad of fat embolism syndrome involves pulmonary changes, cerebral dysfunction and petechial rash. The cornerstone of treatment is preventing the stress response, hypovolemia and hypoxia and operative stabilization of fractures. Corticosteroid are the only drugs which have repeatedly shown a positive effect on the prevention and treatment of fat embolism syndrome. We report a case of post-traumatic fat embolism syndrome with severe cerebral involvement without respiratory distress. A 55 years old female had a traffic accident. She sustained pelvic bone fracture and both humerus fracture. Approximately 4 hours after the accident, mental status change developed without a focal neurologic deficits. She had no respiratory symptom and sign. Her brain MRI showed multiple cerebral fat embolism lesion. The patients received supportive treatment with corticosteroid, albumin. Her neurologic status stabilized over several days. After orthopedic surgery, she was discharged 62 days after admission.

• Journal of Yeungnam Medical Science
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• v.40 no.2
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• pp.207-211
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• 2023

Fat embolism syndrome is a rare but alarming, life-threatening clinical condition attributed to fat emboli entering the circulation. It usually occurs as a complication of long-bone fractures and joint reconstruction surgery. Neurological manifestations usually occur 12 to 72 hours after the initial insult. These neurological complications include cerebral infarction, spinal cord ischemia, hemorrhagic stroke, seizures, and coma. Other features include an acute confusional state, autonomic dysfunction, and retinal ischemia. In this case series, we describe three patients with fat embolism syndrome who presented with atypical symptoms and signs and with unusual neuroimaging findings. Cerebral fat embolism may occur without any respiratory or dermatological signs. In these cases, diagnosis was established after excluding other differential diagnoses. Neuroimaging using brain magnetic resonance imaging is of paramount importance in establishing a diagnosis. Aggressive hemodynamic and respiratory support from the beginning and consideration of orthopedic surgical intervention within the first 24 hours after trauma are critical to decreased morbidity and mortality.

• Biomedical Science Letters
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• v.10 no.2
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• pp.115-120
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• 2004

To investigate the correlation between the magnetic resonance imaging (MRI) of cerebral fat embolism that is induced by injecting oleic acid into 10 cats, and a pathologic diagnosis. Using a microcatheter, 30 ${mu}ell$ of oleic acid was injected into the internal carotid artery of 10 cats. MR T2-weighted image (T2WI), diffusion-weighted image (DWI) and Gadolinium-enhanced T1-weighted image (Gd-enhanced T1WI) were obtained after 30 minutes and 2 hours of embolization. After 30 minutes of the embolization, lesions of very high signal intensity were detected by T2WI in 6 cats, and of slightly high signal intensity in 2 cats; in the remaining 2 cats, signal intensity was normal. DWI showed lesions of very high intensity in 9 cats and of slightly high intensity in one cat. According to the findings of light microscopic examination, infarcted lesions mainly involved the gray matter, but also some white matter. A magnetic resonance imaging diagnosis for cerebral fat embolism that was induced by oleic acid through the internal carotid artery in cats showed high signal intensity on the T2WI and the DWI within an initial 2 hours, and with a well enhancement on the Gd-enhanced T1WI. Considering cellular edema, cerebrovascular injury and extracellular space widening, we assumed pathologically that cytotoxic and vasogenic edema exists at the same time.

• Biomedical Science Letters
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• v.10 no.4
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• pp.515-521
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• 2004

To measure regional cerebral blood volume (rCBV) with perfusion MR imaging of cerebral fat embolism by neutral fat and free fatty acids in cats. Triolein (group 1, n=15), oleic acid (group 2, n=9) and linoleic acid (group 3, n=11) were infused into unilateral internal carotid artery using microcatheter through the transfemoral approach. PVA particle was used as a non-fat embolic material in a control group (group 4, n=9). Perfusion-weighted MR image was obtained at 30 minutes and 2 hours postembolization, based on T2-and diffusion-weighted images. The data of lesion and contralateral normal area were transferred to personal computer, time-to-signal intensity curve was drawn and trans for used to △R2/sup */ curve in regular order. The process in the personal computer was done by using the author's developmental image processing program and interactive data language (IDL) softwares. Statistical significance was approved by paired t-test and ANOVA. rCBV of the lesion was decreased comparing to the normal area in all groups. The ratios of rCBV were as follows (group No, at 30 minutes, at 2 hours); group 1,32％, 51％; group 2, 30％, 44％; group 3, 39％, 61％; group 4, 21％, 36％. rCBVs of 2 hours was significantly increased compared to those of 30 minutes in all groups (P<0.005). rCBV was decreased at 30 minutes in cerebral fat embolism and recovered a little, but significantly at 2 hours. Perfusion-weighted images was useful method in offering hemodynamic information in cerebral fat embolism.

• The Journal of the Korea Contents Association
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• v.5 no.5
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• pp.296-304
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• 2005

Quantitative analysis compare to dynamic characteristic change of the regional cerebral blood volume(rCBV) after development of cerebral fat embolism in cats using perfusion magnetic resonance(MR) Imaging. Twenty cats were used. Linoleic acid (n=11) were injected into the internal carotid artery using microcatheter through the transfemoral approach. Polyvinyl alcohol (Ivalon) (n=9) was injected as a control group. Perfusion MR images were obtained at 30 minutes and 2 hours after embolization, based on T2 and diffusion-weighted images. The data was time-to-signal intensity curve and ${\Delta}R_2^*$ curve were obtained continuously with the aid of home-maid image process algorithm and IDL(interactive data Banguage, USA) softwares. The ratios of rCBV increased significantly at 2 hours compared with those of 30 minutes (P<0.005). In conclusion, cerebral blood flow decreased in cerebral fat embolism immediately after embolization and recovered remarkably in time course. It is thought that clinically informations to dynamic characteristic change of the cerebral hemodynamics to the early finding in cerebral infarction by diffusion weighted imaging(DWI) and perfusion weighted imaging(PWI).

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.103-106
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• 2018

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of -86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

• Journal of Korean Neurosurgical Society
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• v.51 no.5
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• pp.312-315
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• 2012

We report magnetic resonance image (MRI) and magnetic resonance spectroscopy (MRS) findings in a patient of cerebral fat embolism (CFE) occurred in a 26-year-old woman after an autologous fat injection into the face. After initial neurologic symptom onset, MRI and MRS data were obtained two times to investigate repeated CFE. We obtained the MRS data in the two different time intervals and two different echo times to compare the lesions with normal brain parenchyma. The results of MRS data showed that a decrease in N-acetyl-aspartate, an increase in lactate and a very high early peak of free lipids between 0.9 and 1.4 ppm were obtained at the acute infarcted lesion as compared with normal brain parenchyma. In addition, these findings were more clearly detected on short echo time spectrum rather than long spectrum. A close relationship between the clinical manifestations and MRI and MRS findings of the brain can helpful to distinguish CFE with other conditions and to evaluate the cause materials of infarctions rather than conventional MRI or diffusion-weighted imaging.

• Biomedical Science Letters
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• v.10 no.3
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• pp.285-291
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• 2004

To determine the magnetic resonance (MR) imaging findings and natural history of cerebral fat embolism in a cat model, and to correlate the MR imaging and histologic fmdings. Intemel carotid artery of 11 cats was injected with 0.1 ml of triolein. T2-weighted, T1-weighted and Gd-enhanced T1-weighted images were obtained serially for 2 hours, 1 days, 4 days, 1 week, 2 weeks and 3 weeks after embolization. Any abnormal signal intensity was evaluated. After MR imaging at 3 weeks, brain tissue was obtained for light microscopic (LM) examination using hematoxylin-eosin (HE) and Luxol fast blue staining, and for electron microscopic examination. The LM examination with HE staining revealed normal histological findings in the greater part of an embolized lesion. Cystic change was observed in the gray matter of 8 cats, while in the gray and white matter of 3 cats. At LM examination, Luxol fast blue, staining demonstrated demyelination around the cystic change occurring in the white matter, and EM examination of the embolized cortex revealed sporadic intracapillary fat vacuoles (n=11) and disruption of the blood-brain barrier (n=4). Most lesions were normal, however, and perivascular interstitial edema and cellular swelling were mild compared with the control side. The greater part of an embolized lesion showed reversible findings at MR and histological examination. Irreversible focal necrosis was, however, observed in gray and white matter at weeks 3.