Fowler James B, Fiani Brian, Sarhadi Kasra, Cortez Vladimir
Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, United States.
Department of Neurology, University of Washington, Seattle, Washington, United States.
Surg Neurol Int. 2021 Mar 2;12:78. doi: 10.25259/SNI_946_2020. eCollection 2021.
The classic triad of fat embolism syndrome consists of pulmonary distress, mental status change, and petechial rash. Typically, symptoms manifest 24-48 hours after a long bone fracture, but case reports have demonstrated fat embolism syndrome without long bone fracture. These cases are initiated by a stress response, mobilizing free fatty acids into the circulation.
Herein, we present the case of a 70-year-old male who presented with the left-sided hemiparesis and was subsequently found to have tandem lesions of the right internal carotid artery (ICA) and right middle cerebral artery (MCA) warranting emergent mechanical thrombectomy (MT). The ensuing pathology report determined the source of ischemic stroke to be caused by fat embolism, a rare and intriguing case of cryptogenic large vessel occlusion (LVO) with unique features distinguishing it from other reports in the literature.
According to the biochemical theory, a catecholamine surge can precipitate fat globules forming in the circulatory system, leading to tissue hypoxia, injury, and ischemia. While the majority of cerebral fat emboli cause reversible ischemia of small diameter vessels, our case presents with LVO and tandem lesions in both the ICA and MCA resulting in infarct and residual hemiparesis.
脂肪栓塞综合征的典型三联征包括肺部窘迫、精神状态改变和瘀点皮疹。通常，症状在长骨骨折后24 - 48小时出现，但病例报告显示无长骨骨折的脂肪栓塞综合征。这些病例由应激反应引发，使游离脂肪酸进入循环系统。
在此，我们报告一例70岁男性病例，该患者出现左侧偏瘫，随后发现右侧颈内动脉（ICA）和右侧大脑中动脉（MCA）串联病变，需要紧急进行机械取栓术（MT）。随后的病理报告确定缺血性卒中的病因是脂肪栓塞，这是一例罕见且引人关注的隐源性大血管闭塞（LVO）病例，具有与文献中其他报告不同的独特特征。
根据生化理论，儿茶酚胺激增可促使循环系统中形成脂肪球，导致组织缺氧、损伤和缺血。虽然大多数脑脂肪栓子会导致小直径血管的可逆性缺血，但我们的病例表现为ICA和MCA的LVO及串联病变，导致梗死和残留偏瘫。
