Cerebral Embolization Presenting as Delayed, Severe Obtundation in the Postanesthesia Care Unit After Total Hip Arthroplasty

• Published in: Mayo Clinic proceedings Vol. 75; no. 11; pp. 1209 - 1213
• Main Authors: Ott, Michael C., Meschia, James F., Mackey, David C., Brodersen, Mark P., Burger, Charles, Echols, J. Dan, Fenton, Douglas S.
• Format: Journal Article
• Language: English
• Published: Rochester, MN Elsevier Inc 01.11.2000; Mayo Medical Ventures; Elsevier Limited
• Subjects: Anesthesia Recovery Period; Arthroplasty, Replacement, Hip; Biological and medical sciences; Consciousness Disorders - diagnosis; Consciousness Disorders - etiology; Diagnosis, Differential; Embolism, Fat - etiology; Female; Humans; Intracranial Embolism - etiology; Magnetic Resonance Imaging; Medical sciences; Middle Aged; Orthopedic surgery; Postoperative Complications; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; CT; MRI; PACU; Human; Hip joint; Postoperative; Nervous system diseases; Fat embolism; Prosthesis; Consciousness impairment; Cerebral embolism; Cardiovascular disease; Differential diagnostic; Cerebral disorder; Vascular disease; Case study; Orthopedic surgery; Central nervous system disease; Adult; Complication; Female; Neurological disorder; Cerebrovascular disease
• ISSN: 0025-6196; 1942-5546
• DOI: 10.4065/75.11.1209

Catastrophic neurologic events occur rarely postoperatively and must be diagnosed quickly. A 63-year-old woman who had undergone uneventful total hip arthroplasty experienced obtundation after admission to the postanesthesia care unit. Cranial magnetic resonance imaging revealed multiple lesions consistent with ischemia or infarction, and fat cerebral embolism was diagnosed. We describe the numerous complications that may occur in patients in the postanesthesia care unit and review the differential diagnosis of altered mental status in such pa tients. Paradoxical cerebral fat embolization must be considered in the differential diagnosis of altered mental status after pelvic or long bone fracture or lower extremity major joint replacement, and this condition may occur despite normal pulmonary function and no patent foramen ovale or right-to-left intracardiac shunt. Magnetic resonance imaging with T 2-weighted sequences is the cranial imaging study of choice for early evaluation of patients with sudden multifocal neurologic deficits and suspected fat embolism syndrome.