A case of cerebral fat embolism manifested by motor aphasia *
A 17 years old female was injured in a traffic accident, involving a fracture in a shaft of It. femur and excoriated wounds in her forehead. On admission, she was alert and had no neurological deficits, showing no abnormalities in CT scan of the head and plain craniogram. Her femur was tractioned by wire and planned to be fixed by an intentionally delayed operation. Forty eight hours alter injuries, she had motor aphasia and petechial rashes in her anterior chest and palpebral conjunctiva. Chest X-ray, performed immediately after the occurence of these signs, was normal. A cerebral fat embolism was diagnosed under Gurd's criteria. An intravenous infusion of 250 ml of Lactated Ringer's solution containing 10% of dextran-40, twice a day and O2 inhalation were used. On 72 hours after injury, EEG showed diffuse slow wave pattern and 99mTc-HM-PAO SPECT showed low perfusion in the cerebral white matter around It-basal ganglia, but CT scan still showed no abnormalities. Ten days after injury, motor aphasia was completely improved. MRI performed on both 8 days and 1 month alter injury showed small multiple spotted T1WI-low and T2Wi-high intensity areas in the It-parietal white matter, brain stem and bilateral centrum semiovale. It is generally accepted that cerebral fat embolism is one of the serious complications of fractures of long bone with the features of respiratory failure, cerebral involvement and petechial rush. However, it is not rare to mis-diagnose, pariticulary in cases of multiple injuries including the head presenting neurological deficits and impairment of consciousness. It is also pointed out that the incidence of cerebral fat embolism is increased in the case of delayed operation of the long bone fractures due to associated neurological deficits by brain injury. In this case report, we demonstrated that motor aphasia was an ischemic sign in the white matter around the It-motor speech area due to the cerebral fat embolism supported by the findings including MRI, EEG and CBF-SPECT study. It is concluded that early surgical plastic surgery should be performed for long bone fractures to prevent cerebral fat embolism, and that cerebral fat embolism sholud be treated as soon as possible after the occurence of neurological deficits. (Accepted on August 8 , 1998) Kawasaki Igakkaishi 24(2) : 93-99, 1998
