Total recovery from severe fat embolism syndrome complicated with status epilepticus: a case report
Po-Kuan Yeh, MD 1 ,
1 Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Yueh-Feng Sung , PhD, MD
Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Fat embolism syndrome (FES) means that fat emboli, originating from long bone or pelvic fracture, occlude the vessels of any organ (especially lung, brain and skin, the triad of FES). Most patients with FES fully recover spontaneously, but neurological abnormalities may exist in severe FES. Herein, we present a case of severe FES who was treated hyperbaric oxygen therapy (HBO) and cerebrolysin treatment, had complete recovery of neurological deficits 5 months later.
MATERIAL and METHOD:
FES with coma and status epilepticus indicates a severe brain damage. Early intervention with HBO and cerebrolysin treatment may enhance microcirculation, decrease neuronal injury, and facilitate recovery. Further research about efficiency and mechanisms of HBO and cerebrolysin treatment for FES is warranted.
A 23-year-old male, without any past medical history, suffered from traffic accident with right upper femoral shaft fracture. While waiting for the surgery at hospital, he was found sudden onset of consciousness loss and generalized tonic-clonic seizure 10 hours after the traffic accident. He was intubated immediately with mechanical ventilation. Blood test showed elevated d-dimer. Brain MRI showed "starfield" pattern of diffuse, punctate, hyperintense lesions on diffusion-weighted imaging over bilateral cerebral and cerebellar hemispheres. FES combined with pulmonary embolism was diagnosed. Anti-epileptic drugs (AED) were administered due to intermittent generalized seizure. Low molecular weight heparin was prescribed initially but discontinued later due to deep femoral artery bleeding. He received trans-catheter arterial embolism, and open reduction and internal fixation of right proximal femoral shaft fracture. Due to persistent consciousness disturbance, HBO therapy and cerebrolysin infusion were instituted. His general condition stabilized gradually, and he regained full consciousness 10 days after admission. Recovery of cognitive function was noted completely 5 months later. No further seizure was found, and the follow-up EEG showed no abnormalities. AED was discontinued 1 year later. No neurological sequalae was reported.