Transient cortical blindness in fat embolism syndrome—a diagnostic enigma

• 作者: Mirza Kiyana Acharya Prashant Upendra Austine Jose
• 来源期刊: 中华创伤杂志英文版
• 关键词: Fat embolism Cortical blindness Bone fractures
• 年，卷（期）: 2021,（2）
• 所属期刊栏目: Case Report
• 页码范围: 79-82
• 页数: 4页
• 语种: 中文
• DOI: 10.1016/j.cjtee.2021.02.005

摘要

Fat embolism syndrome (FES) is a serious life-threatening manifestation of the fat embolism phenomenon characterized by Bergman’s triad of dyspnea, petechiae and mental confusion. While fat embolization into systemic circulation is common, FES occurs in a meagre 0.05%-3% of patients having isolated long bone fractures. Though visual symptoms are commonly attributed to fat embolism retinopathy and is a later occurrence, it may not always be the case. Cortical blindness has been seldom reported in association with FES, and less so as a presenting complaint. Furthermore, no previous literature has described the same in context of an isolated tibia fracture. We report a 20-year-old gentleman with an isolated right tibia shaft fracture who developed sudden onset diminution of vision in both eyes less than 24 h following trauma with no other complaints. Lack of any remarkable ophthalmoscopic findings or other symptoms left us with a diagnostic conundrum. He later went on to develop altered mentation, hypoxia and generalized tonic-clonic seizures with subsequent MRI revealing multiple cerebral fat emboli also involving both occipital lobes. Supportive measures were instituted and his general condition as well as vision gradually improved following which he underwent plate fixation of the fracture under spinal anaesthesia. The perioperative period was uneventful and he was discharged following staple removal. At one month of follow-up, the patient had no residual visual field defects or neurological deficits. Though FES is rare among isolated tibia fractures, this clinical catastrophe may strike in any unsuspected setting thereby warranting a high index of suspicion to ensure early diagnosis and improved patient outcomes.