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(Stroke. 1999;30:2687.)
© 1999 American Heart Association, Inc.

Original Contributions

Transcranial Doppler Detection of Fat Emboli

Alejandro M. Forteza, MD; Sebastian Koch, MD; Jose G. Romano, MD; Gregory Zych, DO; Iszet Campo Bustillo, MD; Robert C. Duncan, PhD Viken L. Babikian, MD

From the Departments of Neurology (A.M.F., S.K., J.G.R., I.C.), Orthopedic Surgery (G.Z.), Epidemiology and Public Health (RC.D.) University of Miami School of Medicine and the Department of Neurology, Boston University School of Medicine, Boston VAMC (V.L.B.).

Background and Purpose—The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler.

Methods—Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small.

Results—Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale.

Conclusions—Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications.

Key Words: cerebral embolism • embolism, fat • trauma • ultrasonography, Doppler, transcranial

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