NDLI: Massive cerebral involvement in fat embolism syndrome and intracranial pressure management.

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Massive cerebral involvement in fat embolism syndrome and intracranial pressure management.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kellogg, Robert G. Fontes, Ricardo B. V. Lopes, Demetrius K.
Description	Author Affiliation: Kellogg RG ( Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.)
Abstract	Fat embolism syndrome (FES) is a common clinical entity that can occasionally have significant neurological sequelae. The authors report a case of cerebral fat embolism and FES that required surgical management of intracranial pressure (ICP). They also discuss the literature as well as the potential need for neurosurgical management of this disease entity in select patients. A 58-year-old woman presented with a seizure episode and altered mental status after suffering a right femur fracture. Head CT studies demonstrated hypointense areas consistent with fat globules at the gray-white matter junction predominantly in the right hemisphere. This CT finding is unique in the literature, as other reports have not included imaging performed early enough to capture this finding. Brain MR images obtained 3 days later revealed T2-hyperintense areas with restricted diffusion within the same hemisphere, along with midline shift and subfalcine herniation. These findings steered the patient to the operating room for decompressive hemicraniectomy. A review of the literature from 1980 to 2012 disclosed 54 cases in 38 reports concerning cerebral fat embolism and FES. Analysis of all the cases revealed that 98% of the patients presented with mental status changes, whereas only 22% had focal signs and/or seizures. A good outcome was seen in 57.6% of patients with coma and/or abnormal posturing on presentation and in 90.5% of patients presenting with mild mental status changes, focal deficits, or seizure. In the majority of cases ICP was managed conservatively with no surgical intervention. One case featured the use of an ICP monitor, while none featured the use of hemicraniectomy.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	5
Volume Number	119
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2013-11-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Brain Diseases Physiopathology Embolism, Fat Intracranial Pressure Physiology Seizures Etiology Surgery Decompression, Surgical Disease Management Early Diagnosis Complications Femoral Fractures Magnetic Resonance Imaging Neurosurgical Procedures Syndrome Tomography, X-ray Computed
Content Type	Text
Resource Type	Case study Article
Subject	Neurology (clinical) Surgery

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