NHS England, London, UK.
J Med Case Rep. 2023 Oct 7;17(1):444. doi: 10.1186/s13256-023-04142-2.
Here we report the only formally documented case in the United Kingdom, to our knowledge, of a cerebral fat embolism secondary to non-iatrogenic trauma through a Tarlov cyst. This case demonstrates the pathology clearly giving an excellent opportunity to demonstrate a rarely seen pathology as well as illustrating the importance of the patient history to guiding further management.
A middle-aged patient was admitted on the acute medical take complaining of severe headache with photophobia, having just returned after a skiing holiday. Computerised tomography scan of the head showed fat within the anterior horn of both lateral ventricles, and within the subarachnoid space. Re-discussion with the patient and subsequent MRI (Magnetic Resonance Imaging) of the spine identified the pathogenesis of her symptoms: a sacral insufficiency fracture through a Tarlov cyst, causing subarachnoid fat embolism and symptoms of a low-pressure headaches due to a dural leak. Patient was medically managed and discharged with planned follow-up. Due to the Coronavirus pandemic and resolution of the patient's symptoms, they declined further follow up imaging.
The case demonstrates a rarely seen pathology as cause of a common presenting problem, headache. Emphasizing the importance of history taking and appropriate investigations in medical cases that do not conform to the usual diagnosis.
据我们所知，这是在英国报告的首例非医源性创伤通过 Tarlov 囊肿引起的脑脂肪栓塞病例。该病例清楚地展示了病理学，为展示罕见的病理学提供了极好的机会，并说明了患者病史对指导进一步治疗的重要性。
一名中年患者因严重头痛伴畏光，在滑雪度假后刚回到急性内科就诊。头部计算机断层扫描显示两侧侧脑室前角和蛛网膜下腔有脂肪。与患者重新讨论，并对脊柱进行后续磁共振成像（MRI）检查，确定了她症状的发病机制：骶骨 Tarlov 囊肿处的不稳定性骨折导致蛛网膜下腔脂肪栓塞和因硬脑膜漏引起的低压性头痛症状。患者接受了药物治疗并出院，计划进行随访。由于冠状病毒大流行和患者症状的缓解，他们拒绝了进一步的随访影像学检查。
该病例展示了一种罕见的病理学病因引起常见的头痛表现。强调了在不符合常见诊断的医疗病例中，详细询问病史和进行适当检查的重要性。
