Motor Aphasia as a Rare Presentation of Fat Embolism Syndrome; A Case Report

Document Type: CASE REPORT

Authors

1 Department of orthopedics, Shahid sadoughi University of Medical Sciences-Yazd, Iran

2 Shahid sadoughi University of Medical Sciences-Yazd, Iran

3 Department of Emergency Medicine, Shahid Sadoughi University of Medical Sciences-Yazd, Iran

Abstract

 
Fat embolism syndrome is a clinical diagnosis, and diagnostic procedures are not specific. In every trauma patient, Fat embolism syndrome has to be considered as a possibility and supportive treatment should begin as soon as possible. The authors reported a rare case of Fat embolism syndrome whose only neurological symptom was motor aphasia. A young man sustained comminuted femoral shaft fracture following an accident presented dyspnea, motor aphasia and petechial rash. The Po2 and O2 Saturation were 53 and 91.1%. The body temperature was 38.5 °C. The hemoglobin decreased from 12.9 to 8.7 and platelet from 121000 to 84000 mg/dl. The pulse rate was 120 bpm. The CT scan and MRI were normal. Fat embolism syndrome was diagnosed according to both Gurd and Schonfeld criteria ruling out other possible causes. Patient recovered completely. Although rare, focal neurological symptoms and motor aphasia should be kept in mind as a part of diagnostic criteria.

Keywords


  1. Wong MWN, Yung SH, Chan KM, Cheng JCY. Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures. J Trauma. 2004; 56(2):356-62.
  2. Fabian TC, Hoots AV, Stanford DS, Patterson CR, Mangiante EC. Fat embolism syndrome: prospective evaluation in 92 fracture patients. Crit Care Med. 1990; 18(1):42-6.
  3. Jacobson DM, Terrence CF, Reinmuth OM. The neurologic manifestations of fat embolism. Neurology. 1986; 36(6):847-51.
  4. Bouaggad A, Harti A, Elmouknia M, Bouderka MA, Barrou H, Abassi O, et al. Neurologic manifestations of fat embolism. Cah Anesthesiol. 1995;43(5):441-3.
  5. Salazar JA, Romero F, Padilla F, Arboleda JA, Fernandez O. Neurological manifestations of fat embolism syndrome. Neurologia. 1995; 10(2):65-9.
  6. Ishihara Y, Okuno T, Fukuda A, Aoki M, Tanaka S, Suzuki K, et al. A case of cerebral fat embolism manifested by motor aphasia. Kawasaki Medical Journal. 1998; 24(2):93-9.
  7. Gurd AR, Wilson R. The fat embolism syndrome. J Bone Joint Surg Br. 1974; 56(3):408-16.
  8. Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, et al. Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. Ann Intern Med.   1983; 99(4):438-43.
  9. Zenker F. Beitrage zur anatomie und physiologie der lunge. J Braunsdorf. 1861;31.
  10. Guillevin R, Vallée JN, Demeret S, Sonneville R, Bolgert F, Mont’Alverne F, et al. Cerebral fat embolism: usefulness of magnetic resonance spectroscopy. Ann Neurol. 2005; 57(3):434-9.
  11. Eguia P, Medina A, Garcia-Monco JC, Martin V, Monton FI. The Value of Diffusion-Weighted MRI in the Diagnosis of Cerebral Fat Embolism. J Neuroimaging. 2007; 17(1):78-80.
  12. Takahashi M, Suzuki R, Osakabe Y, Asai JI, Miyo T, Nagashima G, et al. Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations. J Trauma. 1999; 46(2):324-7.
  13. Gupta B, Kaur M, D’Souza N, Dey CK, Shende S, Kumar A, et al. Cerebral Fat Embolism: A diagnostic challenge. Saudi J Anaesth. 2011; 5(3):348-52.