Cerebral fat embolism syndrome causing brain death after long-bone fractures and acetazolamide therapy.
A 19-year-old woman with multiple fractures and mild brain injury developed severe cerebral fat embolism syndrome after "damage control" orthopaedic surgery. Acetazolamide therapy to manage ocular trauma, in association with hyperchloraemia, caused a profound metabolic acidosis with appropriate compensatory hypocapnia. During ventilator weaning, unexpected brainstem coning followed increased sedation and brief normalisation of arterial carbon dioxide concentration. Autopsy found severe cerebral fat embolism and brain oedema. In patients with multiple trauma, cerebral fat embolism syndrome is difficult to diagnose, and may be more common after delayed fixation of long-bone fractures. Acetazolamide should be used with caution, as sudden restoration of normocapnia during compensated metabolic acidosis in patients with raised intracranial pressure may precipitate coning.
Walshe
Criona M
CM
Alfred Hospital, Melbourne, VIC, Australia. crionawalshe@hotmail.com
Cooper
James D
JD
Kossmann
Thomas
T
Hayes
Ivan
I
Iles
Linda
L
D000086:Acetazolamide / Q000009:adverse effects; D000328:Adult; D002257:Carbonic Anhydrase Inhibitors / Q000009:adverse effects*; D004620:Embolism, Fat / Q000139:chemically induced / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000628:therapy; D006801:Humans; D009104:Multiple Trauma / Q000150:complications* / Q000628:therapy
D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide