Sokol Zachary, Gonzalez Glenn A A, Lopez Alejandro, Harrop Jim, Jabbour Pascal
Lewis Katz School of Medicine, Temple University, Philadelphia, USA.
Neurological Surgery, Thomas Jefferson University, Philadelphia, USA.
Cureus. 2024 May 29;16(5):e61338. doi: 10.7759/cureus.61338. eCollection 2024 May.
Fat embolism syndrome is a common occurrence after orthopedic trauma and surgery. Cerebral fat embolism (CFE) may arise after fat globules enter the arterial circulation. The neurological manifestations of CFE vary and generally carries a favorable outcome. A small number of reports exist regarding patients with CFE who experienced severe neurological deficits and significant edema on radiographic studies, and subsequently underwent decompressive hemicraniectomy (DHC), some of which had full neurological recoveries. Here, we present the case of a 21-year-old male who presented after a motorcycle accident with multiple orthopedic injuries, who after fixation did not awake from anesthesia. The patient was ultimately found to have cerebral fat emboli, and developed significant edema and swelling. The patient underwent DHC with subsequent cranioplasty and returned to his neurological baseline seven months after his initial injury. DHC for CFE has been described in a few cases with some patients have had substantive recoveries, including the present case. This case emphasizes the importance of promptly recognizing and reversing elevated intracranial pressures and the possibility of promising recoveries.
脂肪栓塞综合征是骨科创伤和手术后的常见并发症。当脂肪球进入动脉循环后，可能会引发脑脂肪栓塞（CFE）。CFE的神经学表现各异，总体预后良好。关于CFE患者出现严重神经功能缺损且影像学检查显示有明显水肿，随后接受减压性颅骨切除术（DHC）的报告较少，其中一些患者神经功能完全恢复。在此，我们报告一例21岁男性患者，该患者在摩托车事故后出现多处骨科损伤，固定术后未从麻醉中苏醒。最终发现该患者患有脑脂肪栓子，并出现明显水肿和肿胀。患者接受了DHC及随后的颅骨成形术，受伤七个月后神经功能恢复至基线水平。已有少数关于CFE行DHC的病例报道，部分患者取得了实质性恢复，包括本例。该病例强调了及时识别和缓解颅内压升高的重要性以及有望实现恢复的可能性。
