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Cerebral fat embolism diagnosed by magnetic resonance imaging at one, eight, and 50 days after hip arthroplasty: a case report

[L’embolie graisseuse cérébrale diagnostiquée par imagerie par résonance magnétique aux jours 1, 8 et 50 après une arthroplastie de la hanche : une étude de cas]

Nobuko Sasano, MD PhD^*, Susumu Ishida, MD, Shinichiro Tetsu, MD, Hiroe Takasu, MD PhD, Kiyoshi Ishikawa, MD PhD, Hiroshi Sasano, MD PhD^* and Hirotada Katsuya, MD PhD^*

^* From the Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences; and
the Department of Anesthesia, Nagoya Daini Red Cross Hospital, Nagoya, Japan.

Address correspondence to: Dr. Nobuko Sasano, Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya 467-8601, Japan. Phone: +81-52-853-8281; Fax: +81-52-852-1148; E-mail: nobusasano{at}aol.com

Purpose: To describe cardiovascular collapse during a cemented hip hemiarthroplasty in a patient who, despite a successful cardiopulmonary resuscitation, remained in a persistent vegetative state due to cerebral fat embolism diagnosed by magnetic resonance imaging (MRI).

Clinical features: A 75-yr-old woman with no medical history underwent cemented hip hemiarthroplasty under spinal anesthesia for a right femoral neck fracture. Shortly after insertion of the prosthesis, a sudden oxygen desaturation, hypotension, bradycardia, and cardiac arrest occurred. The patient was successfully resuscitated, but did not regain consciousness. The patient developed high-grade fever, thrombocytopenia, anemia, and oliguria. MRI scans of the brain revealed multiple high intensity signals throughout the white matter, the basal ganglia, the cerebellum, and the brain stem. The diagnosis of fat embolism was made on the basis of clinical findings and MRI images. Although her cardiorespiratory status improved over the next week, the patient remained in a persistent vegetative state.

Conclusion: When fat embolism is suspected, serial MRI scans of the brain should be performed to diagnose the etiology of cerebral embolism as well as to evaluate the severity of brain damage.

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