Document Detail

Paradoxical cerebral embolisation. An explanation for fat embolism syndrome.
MedLine Citation:
PMID:  14765873     Owner:  NLM     Status:  MEDLINE    
Fat embolism occurs following fractures of a long bone or arthroplasty. We investigated whether paradoxical embolisation through a venous-to-arterial circulation shunt (v-a) could lead to cerebral embolisation during elective hip or knee arthroplasty. Transcranial Doppler ultrasound (TCD), following the intravenous injection of microbubble contrast, identified the presence of a shunt in 41 patients undergoing hip (n = 20) or knee (n = 21) arthroplasty. Intra-operative cerebral embolism was detected during continuous TCD monitoring. Of the 41 patients, 34 had a v-a shunt of whom 18 had an embolism and embolism only occurred in patients with a shunt (p = 0.012). Spontaneous and larger shunts were associated with a greater number of emboli (rs = 0.67 and rs = 0.71 respectively, p < 0.01). Observations in two patients with large spontaneous shunts revealed 368 and 203 emboli and unexplained post-operative confusion and pancreatitis. Paradoxical cerebral embolisation only occurred in patients with a shunt and may explain both postoperative confusion and fat embolism syndrome following surgery.
G Riding; K Daly; S Hutchinson; S Rao; M Lovell; C McCollum
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. British volume     Volume:  86     ISSN:  0301-620X     ISO Abbreviation:  J Bone Joint Surg Br     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-02-09     Completed Date:  2004-02-24     Revised Date:  2010-11-10    
Medline Journal Info:
Nlm Unique ID:  0375355     Medline TA:  J Bone Joint Surg Br     Country:  England    
Other Details:
Languages:  eng     Pagination:  95-8     Citation Subset:  AIM; IM    
Academic Surgery Unit, South Manchester University Hospital, Southmoor Road, Manchester M23 9LT, England, UK.
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MeSH Terms
Aged, 80 and over
Arthroplasty, Replacement, Hip / adverse effects*
Arthroplasty, Replacement, Knee / adverse effects*
Embolism, Fat / etiology*
Embolism, Paradoxical / etiology*
Intracranial Arteriovenous Malformations / complications*,  ultrasonography
Intracranial Embolism / etiology*
Intraoperative Care
Middle Aged
Ultrasonography, Doppler, Transcranial

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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