Difusión por resonancia magnética en el diagnóstico precoz de la embolia grasa cerebral / Diffusion-weighted MRI in early diagnosis of cerebral fat embolism syndrome

Introducción. El síndrome de embolia grasa (SEG) es una entidad de difícil diagnóstico y una causa importantede morbimortalidad en pacientes con politraumatismos. Caso clínico. Hombre de 19 años que ingresa con fracturaabierta de tibia y peroné sin traumatismo craneal niclínica neurológica. La fractura se reduce quirúrgicamentemediante osteosíntesis, presentando a las pocas horas, deforma brusca, un cuadro confusional y mioclonías en miembrossuperiores, sin otras manifestaciones. Se practica tomografíacomputarizada craneal y punción lumbar con resultados normales. El electroencefalograma demuestraactividad punta-onda frontotemporal con generalización. Con el diagnóstico de estatus epiléptico es tratado con valproato intravenoso con mejoría del nivel de conciencia y desaparición de las mioclonías. La imagen por resonanciamagnética (RM) cerebral practicada 68 h después muestra múltiples lesiones isquémicas agudas en coronas radiadas.La ecocardiografía no evidencia foramen oval permeable. El paciente es dado de alta sin secuelas con el diagnóstico deSEG. En la RM de control a las 5 semanas persisten las lesionessin restricción en secuencia de difusión.Conclusiones. El SEG es una complicación frecuente, infradiagnosticada y potencialmente grave que se debe considerar en pacientes politraumatizados. La manipulación llevada a cabo en la reducción ortopédica parece tener unpapel importante en su patogenia. La RM permite el diagnóstico y la caracterización de las lesiones agudas en el sistema nervioso central, descartando otras etiologías (AU)

Introduction. Fat embolism syndrome (FES) is a potentially serious, but poorly diagnosed, complication inpolytraumatized patients. Case report. A 19 year-old male was admitted inour hospital with tibia and fibula fracture and no evidence of cranial traumatism or neurological symptoms.He underwent surgical reduction and internal fixation of the fractures. A few hours later, his consciousnesssuddenly deteriorated and he developed myoclonic jerks in his upper limbs. A computed tomography scan of thebrain and lumbar puncture showed no abnormalities.The electroencephalograph demonstrated frontotemporalspike-wave activity with tendency to generalization.Diagnosed of epileptic status, he was treated with intravenous valproic acid. The myoclonia disappeared andthe patient regained consciousness. A magnetic resonance imaging (MRI) scan of the head performed 68 hlater showed multiple high intensity signals throughout the white matter which were seen on the diffusionweighted images as bright spots. Echocardiography did not demonstrate patent oval foramen. The patient wasdischarged from hospital without sequels and with the diagnosis of FES. The control MRI at 5 weeks showedthe persistence of the lesions without restriction in diffusionsequence. Conclusions. FES is a frequent complication that is underdiagnosed and potentially serious. It should beconsidered in polytraumatized patients. The manipulation performed in the orthopedic reduction seems to haveplayed an important role in the patient’s condition. MRI allows for the diagnosis and characterization of acute lesions in the central nervous system, ruling outother etiologies (AU)

[Diffusion-weighted MRI in early diagnosis of cerebral fat embolism syndrome]. / Difusión por resonancia magnética en el diagnóstico precoz de la embolia grasa cerebral.

INTRODUCTION: Fat embolism syndrome (FES) is a potentially serious, but poorly diagnosed, complication in polytraumatized patients. CASE REPORT: A 19 year-old male was admitted in our hospital with tibia and fibula fracture and no evidence of cranial traumatism or neurological symptoms. He underwent surgical reduction and internal fixation of the fractures. A few hours later, his consciousness suddenly deteriorated and he developed myoclonic jerks in his upper limbs. A computed tomography scan of the brain and lumbar puncture showed no abnormalities. The electroencephalograph demonstrated frontotemporal spike-wave activity with tendency to generalization. Diagnosed of epileptic status, he was treated with intravenous valproic acid. The myoclonia disappeared and the patient regained consciousness. A magnetic resonance imaging (MRI) scan of the head performed 68 h later showed multiple high intensity signals throughout the white matter which were seen on the diffusion weighted images as bright spots. Echocardiography did not demonstrate patent oval foramen. The patient was discharged from hospital without sequels and with the diagnosis of FES. The control MRI at 5 weeks showed the persistence of the lesions without restriction in diffusion sequence. CONCLUSIONS: FES is a frequent complication that is underdiagnosed and potentially serious. It should be considered in polytraumatized patients. The manipulation performed in the orthopedic reduction seems to have played an important role in the patient's condition. MRI allows for the diagnosis and characterization of acute lesions in the central nervous system, ruling out other etiologies.

Antiganglioside antibodies in acute self-limiting ataxic neuropathy: incidence and significance.

Antidisialosyl antibodies have been previously associated to chronic and acute ataxic neuropathies. We studied the presence of these antibodies in nine patients with acute self-limiting ataxic neuropathy (ASLAN) using ELISA and TLC immunodetection. One patient showed serum IgG immunoreactivity against gangliosides GD3 and GQ1b. The patient's IgG was able to bind to the nodes of Ranvier on frozen human dorsal root. Our studies confirmed that antidisialosyl reactivity is associated to ataxic neuropathy and its specific binding to the dorsal root could explain the predominant sensory involvement. Nevertheless, the low incidence of this reactivity indicates that a different pathogenic mechanism should be involved in most ASLAN patients.