1/13. Prolonged coma due to cerebral fat embolism: report of two cases.Fat embolism syndrome remains a rare, but potentially life threatening complication of long bone fractures. The true incidence is difficult to assess as many cases remain undiagnosed. Cerebral involvement varies from confusion to encephalopathy with coma and seizures. Clinical symptoms and computed tomography are not always diagnostic, while magnetic resonance imaging is more sensitive in the detection of a suspected brain embolism. Two cases of post-traumatic cerebral fat embolism, manifested by prolonged coma and diffuse cerebral oedema, are presented. The clinical course of the disease as well as the intensive care unit management are discussed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/13. Coma from fat embolism syndrome after hemiarthroplasty of the hip for metastatic breast cancer to the proximal femur: a case report.We present a case report of fat embolism syndrome (FES) that resulted in prolonged coma after cemented hemiarthroplasty in a patient with metastatic breast cancer. After the cemented hip prosthesis was placed, the patient developed decreased sensorium that progressed to coma in association with hypoxemia and tachypnea. Pulmonary compromise was mild, and the patient required only supplemental oxygen for support. The patient demonstrated no petechiae. Magnetic imaging results were consistent with FES. While the pulmonary symptoms resolved quickly, the patient remained unresponsive for 11 days without purposeful motor function. After waking she recovered rapidly, and at her 2-month follow-up appointment, demonstrated no adverse orthopedic, pulmonary, or neurologic sequelae.- - - - - - - - - - ranking = 0.33333333333333keywords = coma (Clic here for more details about this article) |
3/13. Fat embolism, ARDS, coma, death: the four horsemen of the fractured hip.The pathophysiology of fat embolism syndrome (FES) is presented in the context of total joint arthroplasty. The current literature is reviewed with recommendations for surgical technique, anesthetic and pulmonary management. diagnosis is quite difficult but can be established by imaging techniques such as MRI, SPECT, and transcranial Doppler sonography. Early steroid treatment may limit morbidity.- - - - - - - - - - ranking = 0.66666666666667keywords = coma (Clic here for more details about this article) |
4/13. adult postanoxic "erratic" status epilepticus.A 66-year-old woman with posttraumatic anoxic coma after diffuse cerebral fat embolism had continuous alternating-side myoclonic jerks. Usually, this kind of myoclonic status epilepticus (SE) occurs in newborn infants. We postulate the unusual combination of diffuse cerebral anoxia plus commissural fiber damage as a possible explanation.- - - - - - - - - - ranking = 0.16666666666667keywords = coma (Clic here for more details about this article) |
5/13. Cerebral embolization and coma after hysterosalpingography with oil-soluble contrast medium.A case of coma due to embolization after HSG, using oil-soluble contrast medium is presented. The patient was in a comatose state 11 days and then spontaneously regained full consciousness. The safety of oil-contrast medium for HSG is questionable.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/13. Fat embolism syndrome complicating intraarterial chemotherapy with cis-platinum.A 19-year-old man with telangiectatic osteosarcoma of the left proximal femur was started on a course of neoadjuvant chemotherapy consisting of intraarterial administration of cis-platinum. Within 72 hours of receiving the first intraarterial dose, the patient developed signs and symptoms of fat embolism syndrome (FES). A physical examination revealed cyanosis, tachycardia, and seizure activity. Laboratory studies demonstrated a pO2 of less than 65 mmHg, lipuria, and a drop in hematocrit of three percentage points. There was no clinical or roentgenographic evidence of pathologic fracture. Tumor necrosis secondary to intraarterial cis-platinum therapy in this patient with osteosarcoma may have caused a sudden release of free fatty acids and embolization of fat macroglobules that precipitated this episode of FES. FES in association with the intraarterial administration of cis-platinum seems not to have been previously reported.- - - - - - - - - - ranking = 0.33333333333333keywords = coma (Clic here for more details about this article) |
7/13. Pulmonary nodules secondary to total parenteral alimentation.A seven-year-old male, who had a retro-peritoneal alveolar rhabdomyosarcoma and was on total parenteral alimentation (TPN) developed multiple pulmonary nodules, indistinguishable from metastases. These proved to be multiple lipid emboli on open biopsy.- - - - - - - - - - ranking = 0.16666666666667keywords = coma (Clic here for more details about this article) |
8/13. Fat embolism syndrome with total hip replacement.Two cases of fulminant fat embolism syndrome that were fatal are reported as complications of total hip replacement. The major clinical features were severe hypotension and cardiac arrest in one case and postoperative coma in the other case. Both patients had severe acute respiratory failure that resulted from pulmonary oedema.- - - - - - - - - - ranking = 0.16666666666667keywords = coma (Clic here for more details about this article) |
9/13. Periodic EEG patterns in cerebral fat embolism.A 24-year-old male developed fat embolism syndrome (FES) 18 hours after accidental tibial and metatarsal fractures. The onset was characterized by coma, generalized seizures, respiratory distress and hypoxemia. Multiple prolonged portable electroencephalographic (EEG) recordings showed a variety of progressively changing patterns including continuous high amplitude EEG rhythmical synchronous slowing (CHERSS), triphasic waves, bilateral independent periodic lateralized epileptiform discharges (BIPLEDs), frontal intermittent delta activity (FIRDA), and low amplitude irregular generalized theta. Three months after the accident, the patient was neurologically normal and his EEG exhibited only rare brief bursts of anterior theta in the waking recording. I conclude that EEG periodic activity such as CHERSS, triphasic waves, BIPLEDs, and FIRDA can occur in patients suffering from cerebral fat embolism. It reflects a non-specific diffuse encephalopathy not necessarily associated with a poor prognosis. Prolonged and frequent bedside EEG recordings will demonstrate better these fluctuating abnormalities in cerebral fat embolism (and probably in coma of other origin) than standard less frequent recordings. Very likely, these periodic EEG patterns have not been previously identified in cerebral fat embolism because they were not in vogue among electroencephalographers nor widely accepted at the time studies dealing with this syndrome were written.- - - - - - - - - - ranking = 0.33333333333333keywords = coma (Clic here for more details about this article) |
10/13. Residual lesions of cerebral fat embolism.Necropsy findings of a case which survived for three months after massive cerebral fat embolism are presented. The lesions are characterized by numerous patchy necroses and areas of demyelination in the white matter of cerebral and cerebellar hemispheres and brain stem, accompanied by atrophy of white matter and ventricular enlargement. attention is drawn to the significance of these lesions for posttraumatic coma or dementia.- - - - - - - - - - ranking = 0.16666666666667keywords = coma (Clic here for more details about this article) |
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