title: Transcranial doppler detection of fat emboli.
abstract: OBJECTIVE
  The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler.
  
  
  METHODS
  Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small.
  
  
  RESULTS
  Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale.
  
  
  CONCLUSIONS
  Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications.
authors.affiliation: Department of Neurology, University of Miami School of Medicine, FL, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Forteza
authors.forename: S
authors.initials: S
authors.lastname: Koch
authors.forename: J G
authors.initials: JG
authors.lastname: Romano
authors.forename: G
authors.initials: G
authors.lastname: Zych
authors.forename: I C
authors.initials: IC
authors.lastname: Bustillo
authors.forename: R C
authors.initials: RC
authors.lastname: Duncan
authors.forename: V L
authors.initials: VL
authors.lastname: Babikian
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001134:Arm Injuries / Q000150:complications*; D004620:Embolism, Fat / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D005264:Femoral Fractures / Q000150:complications; D005360:Fibula / Q000293:injuries; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D007869:Leg Injuries / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000150:complications; D013978:Tibial Fractures / Q000150:complications; D014458:Ulna Fractures / Q000150:complications; D017585:Ultrasonography, Doppler, Transcranial