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Images in Neurology |

Fat Embolism Syndrome as a Neurologic Emergency

Katharina Hüfner, MD; Markus Holtmannspötter, MD; Hartmut Bürkle, MD; Ulrich C. Schaller, MD; Anne D. Ebert, PhD; Heiko Trentzsch, MD; Hans-Walter Pfister, MD; Christoph B. Lücking, MD
Arch Neurol. 2008;65(8):1124-1125. doi:10.1001/archneur.65.8.1124.
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A 16-year-old girl hit her left leg against a tree while riding horseback. At admission to a community hospital, a tibial wedge fracture was diagnosed and treated conservatively (Figure, A). Twenty hours after the trauma, the patient became nauseous and vomited. Three hours later, automotor seizures occurred, and she became comatose. Endotracheal intubation was performed to protect the airway (Glasgow-Coma Scale 7/15). A diagnostic workup including drug screening, lumbar puncture, standard laboratory testing, 2 cerebral computed tomographic scans, and cerebral computed tomographic angiography revealed no pathologic findings.

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Radiograph of the tibial fracture (A) and typical manifestations of fat embolism syndrome (B-E, G, and H). Note cotton-wool spots on the retina (B) and rash on the trunk (C). Diffusion-weighted magnetic resonance images (D and E) and T2-weighted magnetic resonance images (1.5 T) (G and H) obtained when the patient was initially seen demonstrate punctuate lesions in the white matter and basal ganglia. Magnetic resonance images (3 T) obtained at follow-up demonstrate resolution of these lesions (F and I).

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