A Rare Case of Cerebral Fat Embolism With No Respiratory or Dermatologic Involvement.

Fat embolism syndrome is potentially lethal. It is frequently a complication of long bone fractures and/or orthopedic surgery. Cerebral fat embolism is an unusual condition characterized by purely cerebral involvement. Neurological signs can be variable and brain MRI has a pivotal role in the diagnosis. We report the case of a 69-year-old male who presented motor impairment and a disorder of consciousness in the early postoperative course of total hip arthroplasty for a left femoral neck fracture, which occurred 24 hours before surgery. He had no dermatologic or respiratory signs. No respiratory or dermatologic signs were found. Blood samples showed moderate thrombopenia and hemolytic anemia. Multiple lesions were found on brain MRI. Diagnosis of cerebral fat embolism was established after ruling out differentials.

A Unique Case of Radiologically Isolated Syndrome Diagnosed During a Follow-up of Cytomegalovirus Meningoencephalitis.

Radiologically isolated syndrome (RIS) refers to an entity in which an MRI of the brain, spine, or both demonstrates incidental white matter lesions that are characteristic of a demyelinating disease in morphology and location. High-risk RIS may require disease-modifying treatment (DMT). A complex interaction among genetic and environmental factors leads to self-reactive immune mechanisms, which are believed to have a pivotal role in the pathogenesis of demyelinating diseases. Viruses are possible triggers to this mechanism. Unlike Epstein-Barr virus (EBV) infection, which is a well-known risk factor for multiple sclerosis (MS), the association between cytomegalovirus (CMV) infection and MS remains uncertain, with some studies indicating a protective effect of CMV on autoimmune diseases. We report a unique case of RIS diagnosed during the follow-up of CMV meningoencephalitis in a patient who presented with generalized seizure onset.

Hemiballismus Secondary to Metastatic Lung Cancer: A Case Report.

Hemiballismus is an unusual complication of brain metastasis of lung cancer. A 62-year-old woman suddenly presented with an acute movement disorder characterized by irregular, involuntary, and large-amplitude movements of the left half of her body. Brain magnetic resonance imaging (MRI) revealed metastasis in the right thalamic region. A whole-body CT scan revealed a lung tumor, while a biopsy showed small cell lung carcinoma. Vascular lesions that affect the basal ganglia, particularly the subthalamic nucleus, are the most common cause of hemiballismus. Hemiballismus is generally treated with antipsychotics such as tetrabenazine and haloperidol, but the primary treatment is the causal one. This was demonstrated in our patient since, after completion of the radio-chemotherapy sessions, the hemiballismus gradually decreased.

Anti-Ri-Associated Paraneoplastic Neurological Syndrome Revealing Breast Cancer: A Case Report.

Neurological paraneoplastic syndromes are a rare entity that affects patients with cancer. Anti-Ri antibodies affect the brain stem and produce a heterogeneous rapidly progressive subacute syndrome depending on the involvement of the different regions concerned. The most common clinical presentation is opsoclonus-myoclonus syndrome and paraneoplastic cerebellar degeneration. Here we report a case of a 60-year-old woman with a subacute static-kinetic cerebellar syndrome, cervical dystonia, and multiple cranial nerve palsies revealing a mammary adenocarcinoma. Anti-Ri antibodies were positive in her blood. Our observation underscored the importance of the identification of the tumor for early treatment management to avoid irreversible neurological manifestations.

Cerebral fat embolism syndrome after long bone fracture: A case report.

Cerebral fat embolism is a rare and potentially fatal condition that may occur following a long bone fracture. Its characterized by respiratory, neurological, and mucocutaneous signs. Isolated severe brain syndrome remains exceptional. We report a 21-year-old male patient admitted for the cerebral manifestation of a fat embolism syndrome due to a fracture of long bone after a traffic accident injury. Neurological deterioration after a free interval was seen with generalized tonic-clonic seizures. MRI of the brain was indicated which showed numerous multifocal hyperintensities involving the deep white matter of both hemispheres producing a "starfield" appearance. This pattern of cytotoxic cerebral edema, with lesions in the white matter rather than the grey matter, is indicative of the subacute stage of fat embolism. The patient was treated with comprehensive support in the intensive care unit, he returned to normal neurological function and was discharged after 3 weeks of hospitalization.

Gayet-Wernicke Encephalopathy: An Unusual Complication of Vomiting.

Gayet-Wernicke encephalopathy (WE) is a serious and acute disease of the central nervous system caused by thiamine (vitamin B1) deficiency. Multiple etiologies are indicated, although alcohol abuse is the most reported cause. If not treated promptly, WE can lead to serious complications such as Korsakoff's syndrome, coma, or death. This diagnosis should be considered even without a history of alcohol dependence. We describe two cases of non-alcohol related WE complicating vomiting caused by different etiologies. The diagnosis was suspected on clinical presentation and confirmed by brain MRI and effective response to parenteral administration of thiamine.