Fact-sheet: Fat embolism
Updated on 04/23/2019 at 9:53 AM
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Definition
Fat embolism syndrome is a set of clinical manifestations resulting from fat emboli.
It is a systemic inflammatory reaction, mainly affecting the pulmonary, cerebral, and cutaneous microcirculation (purpura +).
It most often results from long bone fractures.
Cerebral fat embolism can also occur following cardiac or facial surgery. Rarely isolated:
- Diagnosis sometimes difficult, primarily clinical.
- This is a rare and severe syndrome.
- A lucid interval between the fracture and the onset of neurological signs is characteristic.
Clinical features
Varied clinical presentation of cerebral fat embolism:
- Impaired consciousness, seizures, nystagmus, extrapyramidal hypertonia, less frequent and transient focal deficits,
autonomic dysfunction (involvement of the basal ganglia)...
- Retinopathy (retinal hemorrhages, cotton-wool spots, macular edema...)
Laboratory findings
Thrombocytopenia,
Hemolytic anemia.
CT
Brain CT:
Often normal.
Performed first-line in the often traumatic context, allows exclusion of a neurosurgical emergency. May show localized hypodensities, diffuse cerebral edema, cerebral infarcts with hemorrhagic transformation…
MRI
Brain MRI:
Ill-defined lesions, sometimes nodular:
- T1 hypointensities,
- micro-hyperintensities on T2, non-confluent, involving the white matter and cortex,
- T2* hypointensities
Starry sky appearance
resolution of the lesions within a few weeks to a few months.
Management
Symptomatic treatments, resuscitation measures.
Value of albumin administration? (covalent binding with fatty acids, may reduce their toxicity).
outcome usually favorable.
Prognosis depends on pulmonary and cerebral involvement.
Differential diagnosis
Post-traumatic lesions.