Delayed coma in head injury: consider cerebral fat embolism.
OBJECTIVE
To describe a case of a young man with delayed coma after mild head injury, suggestive of cerebral fat embolism (CFE). To underline the value of MR imaging in the differential diagnosis of secondary deterioration in mild head injury.


METHODS
A 21-year-old man admitted with mild head injury after a fall with facial fractures and long bone fractures. He was admitted to the intensive care unit and was mechanically ventilated. Weaning was not possible because of desaturations and pulmonary congestion. Low platelet count and anaemia developed. On several time points during his admission cerebral imaging data were obtained. Non-contrast CT on admission was normal while follow-up MRI showed extensive white matter abnormalities. These imaging abnormalities combined with the clinical presentation suggests cerebral fat embolism (CFE) as the most likely cause of secondary deterioration in our patient.


CONCLUSIONS
In head injured patients with long bone fractures one should consider cerebral fat embolism. When the classical clinical syndrome is not present, MR imaging is warranted for diagnosis and to exclude other causes of secondary deterioration.
Metting
Zwany
Z
Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands. z.metting@neuro.umcg.nl
Rödiger
Lars A
LA
Regtien
Joost G
JG
van der Naalt
Joukje
J
D000328:Adult; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D003128:Coma / Q000209:etiology* / Q000523:psychology; D006259:Craniocerebral Trauma / Q000150:complications* / Q000523:psychology; D004620:Embolism, Fat / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D050723:Fractures, Bone / Q000150:complications; D015600:Glasgow Coma Scale; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D018810:Magnetic Resonance Angiography; D008297:Male; D012121:Respiration, Artificial; D014057:Tomography, X-Ray Computed; D055815:Young Adult