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Cerebral Fat Embolism Syndrome from Penetrating Trauma A Rare Cause-and-Effect.doc

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Cerebral Fat Embolism Syndrome from Penetrating Trauma A Rare Cause-and-Effect

Open Journal of Anesthesiology, 2013, 3, 228-232 /10.4236/ojanes.2013.34052 Published Online June 2013 (/journal/ojanes) Cerebral Fat Embolism Syndrome from Penetrating Trauma: A Rare Cause-and-Effect Stephen J. Gleich , James D. Hannon * *# Department of Anesthesiology, Mayo Clinic, Rochester, USA. Email: gleich.stephen@, # hannon.james@ Received January 26 , 2013; revised March 1 , 2012; accepted April 1 , 2013 th st st Copyright ? 2013 Stephen J. Gleich, James D. Hannon. This is an open access article distributed under the Creative Commons At- tribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is prop- erly cited. ABSTRACT A 42 year-old male sustained an accidental rifle gunshot wound to his left foot, resulting in fracture deformities of the st nd calcaneus, navicular, cuneiform, 1 and 2 metatarsal bases, and talus. As he was transported to our trauma center, he developed progressive encephalopathy. Urgent external fixator placement under general anesthesia was postponed due to his encephalopathy of unknown etiology. Brain magnetic resonance imaging demonstrated a “starfield” pattern of infarcts, consistent with cerebral fat embolism syndrome. Subsequently, he underwent uneventful general anesthesia. The patient was managed supportively and continued to have persistent neurologic dysfunction two months after injury. Keywords: Penetrating Trauma; Cerebral Fat Embolism Syndrome 2. Case Description 1. Introduction An otherwise healthy 42 year-old male sustained an ac- cidental, close-range, gunshot wound to his left foot from a 270-caliber hunting rifle while on a family hunting trip. He was initially evaluated at a local hospital and found to have a normal mental status.