Thicoïpe M, André M, Maurette P, Lassie P, Claverie J P
Service de Réanimation Traumatologique et Post-Chirurgicale, Hôpital Pellegrin, Bordeaux.
Ann Fr Anesth Reanim. 1988;7(5):418-21. doi: 10.1016/S0750-7658(88)80061-3.
A seventeen year old boy sustained pelvic, femoral shaft and malleolar fractures in a road traffic accident. Six hours after admission, the patient became comatose (Glasgow coma score = 7); the coma worsened such that, 24 h later, the coma score was 4. Petechiae were present on the conjunctiva and anterior chest wall. Computed tomography revealed diffuse brain swelling. The diagnosis of cerebral fat embolism was made. There were multiple episodes of severe intracranial hypertension. After 23 days of traction, the femoral fracture was internally fixed. The patient returned home after five months of hospital, with just a few memory and writing problems. Ten months after the accident, magnetic resonance imaging showed a small ventricular dilatation due to subcortical atrophy. Residual ischaemic lesions and demyelination could be seen in the right centrum ovale and temporal lobe. The cerebral lesions contrast with the reversibility of the clinical state.
一名17岁男孩在道路交通事故中遭受骨盆、股骨干和踝关节骨折。入院6小时后，患者昏迷（格拉斯哥昏迷评分=7）；昏迷情况恶化，24小时后昏迷评分为4。结膜和前胸壁出现瘀点。计算机断层扫描显示弥漫性脑肿胀。诊断为脑脂肪栓塞。出现多次严重颅内高压发作。牵引23天后，股骨干骨折进行了内固定。患者住院五个月后回家，仅有一些记忆和书写问题。事故发生十个月后，磁共振成像显示由于皮质下萎缩导致轻度脑室扩张。在右侧卵圆中心和颞叶可见残留的缺血性病变和脱髓鞘。脑部病变与临床状态的可逆性形成对比。
