Wiel E, Fleyfel M, Onimus J, Godefroy O, Leclerc X, Adnet P
Service d'accueil des urgences, hôpital Roger-Salengro, CHRU Lille, France.
Ann Fr Anesth Reanim. 1997;16(8):970-3. doi: 10.1016/s0750-7658(97)82147-8.
A 21-year-old man sustained a closed fracture of the leg from an industrial accident, without associated head trauma. The orthopaedic treatment consisted of immediate immobilization by setting leg in plaster. Two hours after admission, the Glasgow coma scale score was 10. Four hours after admission he developed a coma (Glasgow coma scale score = 7) with repetitive seizures. No lesion was visible on cerebral CT scan. Chest X-ray was unremarkable. Petechiae on the anterior chest wall and abdomen with bilateral mydriasis occurred. Thrombocytopenia with prothrombine time increase were observed. Magnetic resonance imaging, 27 hours after admission, showed high-intensity areas on T2 weighted views due to fat embolism. Retinal haemorrhages were observed. The bronchoalveolar lavage showing fat staining of tracheal aspirates confirmed the diagnosis of fat embolism. This case report emphasizes the possibility of predominant neurologic manifestations of a fat embolism and the diagnostic help of cerebral magnetic resonance imaging.
一名21岁男性在一次工业事故中腿部发生闭合性骨折，无头部外伤。骨科治疗包括立即用石膏固定腿部进行制动。入院两小时后，格拉斯哥昏迷量表评分为10分。入院四小时后，他出现昏迷（格拉斯哥昏迷量表评分 = 7）并伴有反复癫痫发作。脑部CT扫描未见病变。胸部X线检查无异常。前胸壁和腹部出现瘀点，双侧瞳孔散大。观察到血小板减少伴凝血酶原时间延长。入院27小时后的磁共振成像显示，由于脂肪栓塞，T2加权像上出现高强度区域。观察到视网膜出血。支气管肺泡灌洗显示气管吸出物有脂肪染色，证实了脂肪栓塞的诊断。本病例报告强调了脂肪栓塞以神经症状为主的可能性以及脑磁共振成像在诊断中的帮助。
