title: Case report: acute postoperative neurological impairment from fat embolism syndrome.
abstract: OBJECTIVE
  To describe a case of fat embolism syndrome (FES) following elective tendon contracture release in a patient with myotonic dystrophy, to highlight the importance of considering this entity in the differential diagnosis of acute postoperative neurocognitive dysfunction.
  
  
  METHODS
  A 34-yr-old man with myotonic dystrophy underwent uneventful tendon contracture release under regional anesthesia. In the immediate postoperative period, neurological and respiratory complications developed, requiring intensive care support. The patient showed the classical clinical triad of hypoxemia, neurological impairment and a petechial rash associated with the FES. A diagnosis of FES was made and, despite therapy including fluid and inotropic support, the patient succumbed to the condition. There was no demonstrated intracardiac shunt, suggesting a physiological intrapulmonary shunt was responsible for the development of systemic manifestations of FES.
  
  
  CONCLUSIONS
  Postoperative neurological dysfunction is a difficult condition with numerous possible causes. All possible etiologies, including FES, need to be considered in the differential diagnosis and postoperative management of patients developing acute postoperative neurological impairment and hypoxemia.
authors.affiliation: Division of Respirology, Department of Medicine, University of Toronto, Ontario, Canada. kieran.mcintyre@utoronto.ca
authors.forename: Kieran
authors.initials: K
authors.lastname: McIntyre
authors.forename: Susan
authors.initials: S
authors.lastname: French
authors.forename: Toby H
authors.initials: TH
authors.lastname: Rose
authors.forename: Robert
authors.initials: R
authors.lastname: Byrick
mesh_terms: D000208:Acute Disease; D000328:Adult; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D003286:Contracture / Q000601:surgery; D003937:Diagnosis, Differential; D004620:Embolism, Fat / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D010009:Osteochondrodysplasias / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D013577:Syndrome