Cerebral fat embolism diagnosed by magnetic resonance imaging at one, eight, and 50 days after hip arthroplasty: a case report.
OBJECTIVE
To describe cardiovascular collapse during a cemented hip hemiarthroplasty in a patient who, despite a successful cardiopulmonary resuscitation, remained in a persistent vegetative state due to cerebral fat embolism diagnosed by magnetic resonance imaging (MRI).


METHODS
A 75-yr-old woman with no medical history underwent cemented hip hemiarthroplasty under spinal anesthesia for a right femoral neck fracture. Shortly after insertion of the prosthesis, a sudden oxygen desaturation, hypotension, bradycardia, and cardiac arrest occurred. The patient was successfully resuscitated, but did not regain consciousness. The patient developed high-grade fever, thrombocytopenia, anemia, and oliguria. MRI scans of the brain revealed multiple high intensity signals throughout the white matter, the basal ganglia, the cerebellum, and the brain stem. The diagnosis of fat embolism was made on the basis of clinical findings and MRI images. Although her cardiorespiratory status improved over the next week, the patient remained in a persistent vegetative state.


CONCLUSIONS
When fat embolism is suspected, serial MRI scans of the brain should be performed to diagnose the etiology of cerebral embolism as well as to evaluate the severity of brain damage.
Sasano
Nobuko
N
Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya 467-8601, Japan. nobusasano@aol.com
Ishida
Susumu
S
Tetsu
Shinichiro
S
Takasu
Hiroe
H
Ishikawa
Kiyoshi
K
Sasano
Hiroshi
H
Katsuya
Hirotada
H
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004620:Embolism, Fat / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology; D007431:Intraoperative Complications; D008279:Magnetic Resonance Imaging; D018458:Persistent Vegetative State / Q000209:etiology; D012773:Shock, Surgical / Q000209:etiology