Abstract
Objectives
Based on a 16-year case series, we sought lessons about diagnosis and treatment of
cerebral fat embolism syndrome.
Materials and methods
Using discharge codes at a Level 1 Trauma Center, we performed a retrospective chart
review of clinical characteristics, diagnostic studies, treatments, and outcome in
cerebral fat embolism syndrome.
Results
Thirty-nine (40%) of 97 patients with fat embolism syndrome were diagnosed with cerebral
fat embolism syndrome, with 29 (74%) presenting with coma. All had abnormal brain
magnetic resonance imaging, with scattered cytotoxic edema (starfield pattern) in
29 (74%). All but two of the 21 patients with dilated fundoscopy showed retinal embolism.
Among 29 patients with transcranial Doppler, the presence of microembolic signals
in 15 (52%) was associated with fever (p = 0.039), right-to-left intracardiac shunting (p = 0.046) and a trend towards initial coma. In 11 patients with serial transcranial
Dopplers and treatment with high-intensity statin therapy, the frequency of microembolic
signals tended to decrease after therapy was initiated. Of the 28 (72%) of the 39
patients discharged, 16 (57%) had mild to moderate disability at last follow up.
Conclusions
The recognition of cerebral fat embolism syndrome may be improved with routine inclusion
of brain magnetic resonance imaging, dilated fundoscopy, and transcranial Doppler.
We share our empiric management algorithm for cerebral fat embolism syndrome using
these studies and with consideration of experimental therapies in select patients
to prevent ongoing cerebral injury.
Keywords
Abbreviations:
CFES (cerebral fat emboli syndrome), TCD (transcranial Doppler), MES (microembolic signals), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 08, 2022
Accepted:
September 16,
2022
Received in revised form:
September 15,
2022
Received:
May 6,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106794
Copyright
© 2022 Elsevier Inc. All rights reserved.
