Effectiveness of Decompressive Hemicraniectomy to Treat a Life-Threatening Cerebral Fat Embolism.
Journal
Case reports in critical care
ISSN: 2090-6420
Titre abrégé: Case Rep Crit Care
Pays: United States
ID NLM: 101598416
Informations de publication
Date de publication:
2019
2019
Historique:
received:
27
11
2018
revised:
07
02
2019
accepted:
17
02
2019
entrez:
4
4
2019
pubmed:
4
4
2019
medline:
4
4
2019
Statut:
epublish
Résumé
Cerebral fat embolism (CFE) occurs mainly after long-bone fractures. Often reducing to minor neurological disorders as confusion, it can sometimes cause more severe consequences such as coma or even death. While CFE has been described for several years, there is no consensual treatment. We report the case of a 15-year-old girl with a severe cerebral fat embolism secondary to a longboard fall with a femur fracture. She developed in less than 4 hours a coma. On day 4, she lost her brainstem reflexes with a clinical condition close to brain death, with a very high intracranial pressure (ICP) value above 75 mmgH at worst. She was treated as having a trauma brain injury based on ICP control with a decompressive hemicraniectomy. She recovered in some weeks, allowing discharge to a post ICU rehabilitation center, one month after admission. We report a severe case of cerebral fat embolism with good outcome. It was managed as a trauma brain injury. We emphasize the neurological management based on ICP and discuss the position of hemicraniectomy.
Sections du résumé
BACKGROUND AND IMPORTANCE
BACKGROUND
Cerebral fat embolism (CFE) occurs mainly after long-bone fractures. Often reducing to minor neurological disorders as confusion, it can sometimes cause more severe consequences such as coma or even death. While CFE has been described for several years, there is no consensual treatment.
CLINICAL PRESENTATION
METHODS
We report the case of a 15-year-old girl with a severe cerebral fat embolism secondary to a longboard fall with a femur fracture. She developed in less than 4 hours a coma. On day 4, she lost her brainstem reflexes with a clinical condition close to brain death, with a very high intracranial pressure (ICP) value above 75 mmgH at worst. She was treated as having a trauma brain injury based on ICP control with a decompressive hemicraniectomy. She recovered in some weeks, allowing discharge to a post ICU rehabilitation center, one month after admission.
CONCLUSION
CONCLUSIONS
We report a severe case of cerebral fat embolism with good outcome. It was managed as a trauma brain injury. We emphasize the neurological management based on ICP and discuss the position of hemicraniectomy.
Identifiants
pubmed: 30941226
doi: 10.1155/2019/2708734
pmc: PMC6421046
doi:
Types de publication
Case Reports
Langues
eng
Pagination
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