title: High-dose rosuvastatin treatment for multifocal stroke in trauma-induced cerebral fat embolism syndrome: a case report.
abstract: BACKGROUND
  Fat embolism syndrome is a life-threatening condition with treatment centering on the provision of excellent supportive care and early fracture fixation. No pharmacologic intervention has yet shown any clear benefit. We used high-dose rosuvastatin specifically for its anti-inflammatory effects to treat a patient with severe fat embolism syndrome. We also suggest that magnetic resonance imaging and transcranial Doppler studies are helpful in establishing the diagnosis and for monitoring the patient's course.
  
  
  METHODS
  A 17-year-old boy developed severe cerebral fat embolism syndrome with multifocal strokes after sustaining bilateral femur fractures.
  
  
  RESULTS
  In spite of profound and prolonged neurological impairment, our patient experienced dramatic recovery by the time he was discharged from inpatient rehabilitation several weeks after his initial injury. Magnetic resonance imaging revealed the classic "starfield" pattern of infarcts on diffusion-weighted sequences early in the illness. Additionally, serial transcranial Doppler studies demonstrated dramatically elevated microembolic events that resolved completely during the course of treatment.
  
  
  CONCLUSIONS
  We feel that the acute administration of high-dose rosuvastatin early in the development of our patient's illness may have contributed to his ultimate recovery. Therapeutic guidelines cannot be extrapolated from a single patient, but our experience suggests that statin therapy could be potentially beneficial for individuals with severe fat embolism syndrome, and this approach deserves further clinical evaluation. Additionally, the diagnosis and monitoring of cerebral involvement in fat embolism syndrome is facilitated by both magnetic resonance imaging and transcranial Doppler studies.
authors.affiliation: Department of Pediatric Critical Care, University of Arizona, Tucson, Arizona. Electronic address: lesta.whalen@gmail.com.
authors.forename: Lesta D
authors.initials: LD
authors.lastname: Whalen
authors.affiliation: Department of Neurology, Harborview Medical Center, Seattle, Washington.
authors.forename: Sandeep P
authors.initials: SP
authors.lastname: Khot
authors.affiliation: Department of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Standage
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology; D004620:Embolism, Fat / Q000209:etiology* / Q000473:pathology; D005264:Femoral Fractures / Q000150:complications*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D020766:Intracranial Embolism / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D000068718:Rosuvastatin Calcium / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium
keywords: anti-inflammatory; cerebral fat embolism; fat embolism syndrome; statin; stroke