 |
|
Endovascular Closure of a Patent Foramen Ovale in the Fat Embolism Syndrome
Changes in the Embolic Patterns as Detected by Transcranial Doppler
Alejandro M. Forteza, MD;
Alejandro Rabinstein, MD;
Sebastian Koch, MD;
Gregory Zych, DO;
Jay Chandar, MD;
Jose G. Romano, MD;
Iszet Campo Bustillo, MD
Arch Neurol. 2002;59:455-459.
Background The posttraumatic fat embolism syndrome (FES) is characterized by petechiae
and pulmonary and cerebral dysfunction. A patent foramen ovale (PFO) could
worsen the prognosis of FES by allowing larger emboli to reach the systemic
circulation. Transcranial Doppler ultrasonography can be used to diagnose
and monitor cerebral microembolism in FES.
Objective To describe a case of successful percutaneous closure of PFO in a patient
with posttraumatic FES with excellent clinical outcome.
Patient and Methods A 17-year-old girl presented with a posttraumatic long-bone fracture
complicated by typical severe FES. Transcranial Doppler disclosed multiple
microembolic signals over both middle cerebral and basilar arteries. A large
PFO was diagnosed by transesophageal echocardiogram. A brain magnetic resonance
image with diffusion-weighted sequences showed multiple bilateral areas of
abnormal diffusion in watershed territories. Percutaneous PFO closure with
a buttoned device was successfully performed.
Results Closure of PFO was associated with marked reduction in the number and
intensity of microembolic signals. Subsequent surgical repair of the fracture
with the patient under transcranial Doppler monitoring was uneventful. There
was excellent correlation between clinical course and microembolic signal
load by transcranial Doppler.
Conclusions Cerebral fat embolism after long-bone fractures can be detected in vivo
and monitored over time with the use of transcranial Doppler techniques. If
a PFO is present, its closure before surgical manipulation of the fracture
is feasible and could have important protective effects against massive systemic
embolization.
From the Division of Cerebrovascular Diseases, Department of Neurology
(Drs Forteza, Rabinstein, Koch, Romano, and Campo Bustillo), Department of
Orthopedic Surgery (Dr Zych), and Division of Pediatric Cardiology, Department
of Pediatrics (Dr Chandar), University of Miami School of Medicine, Miami,
Fla.
RELATED ARTICLE
Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2002;59(3):492-494.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Causes of brain injury during orthopedic surgery/Les causes de lesion cerebrale pendant la chirurgie orthopedique
Byrick
Canadian J. Anesthesia 2004;51:867-870.
FULL TEXT
|
