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Case report: Acute postoperative neurological impairment from fat embolism syndrome

[Déficit neurologique postopératoire aigu dû à une embolie graisseuse]

Kieran McIntyre, MD^*, Susan French, MD FRCPC, Toby H. Rose, MD FRCPC and Robert Byrick, MD FRCPC

^* From the Division of Respirology, Department of Medicine, University of Toronto; the
Department of Anesthesia, St. Michael’s Hospital; the
Forensic Pathology Unit, Office of the Chief Coroner for Ontario and Department of Laboratory Medicine and Pathobiology, University of Toronto; and the
Department of Anesthesia, St. Michael’s Hospital and University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Kieran McIntyre, 1642 Bathurst St. Toronto, Ontario M5P3J7, Canada. Fax: 519-756-1101; E-mail: kieran.mcintyre{at}utoronto.ca

Purpose: To describe a case of fat embolism syndrome (FES) following elective tendon contracture release in a patient with myotonic dystrophy, to highlight the importance of considering this entity in the differential diagnosis of acute postoperative neurocognitive dysfunction.

Clinical features: A 34-yr-old man with myotonic dystrophy underwent uneventful tendon contracture release under regional anesthesia. In the immediate postoperative period, neurological and respiratory complications developed, requiring intensive care support. The patient showed the classical clinical triad of hypoxemia, neurological impairment and a petechial rash associated with the FES. A diagnosis of FES was made and, despite therapy including fluid and inotropic support, the patient succumbed to the condition. There was no demonstrated intracardiac shunt, suggesting a physiological intrapulmonary shunt was responsible for the development of systemic manifestations of FES.

Conclusions: Postoperative neurological dysfunction is a difficult condition with numerous possible causes. All possible etiologies, including FES, need to be considered in the differential diagnosis and postoperative management of patients developing acute postoperative neurological impairment and hypoxemia.