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LETTER TO EDITOR
Year : 2011  |  Volume : 59  |  Issue : 3  |  Page : 474-475

Middle cerebral artery occlusion following autologous bitemporal fat injection


1 Department of Neurology, Southwest Hospital, The Third Military Medical University, Chongqing, China
2 Department of Radiology, Southwest Hospital, The Third Military Medical University, Chongqing, China

Date of Submission03-Jan-2011
Date of Decision03-Jan-2011
Date of Acceptance05-Jan-2011
Date of Web Publication7-Jul-2011

Correspondence Address:
Wei Chen
Department of Radiology, Southwest Hospital, The Third Military Medical University, Chongqing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.82749

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How to cite this article:
Hu J, Chen W, Wu Y, Chen K, Luo C, Liang Y, Shi S. Middle cerebral artery occlusion following autologous bitemporal fat injection. Neurol India 2011;59:474-5

How to cite this URL:
Hu J, Chen W, Wu Y, Chen K, Luo C, Liang Y, Shi S. Middle cerebral artery occlusion following autologous bitemporal fat injection. Neurol India [serial online] 2011 [cited 2021 Jul 29];59:474-5. Available from: https://www.neurologyindia.com/text.asp?2011/59/3/474/82749


Sir,

Fat embolism syndrome (FES) manifests more frequently in closed fractures of the pelvis or long bones or following surgery. Cerebral symptoms can be seen in up to 80% of patients. [1],[2] Clinical characteristics of cerebral fat embolism (CFE) are variable and nonspecific. Management strategies include anticoagulation, antiplatelet agents, steroids, alcohol, dehydrants and hyperbaric oxygen. [3] We report a patient who developed embolic stroke following bitemporal autologous fat injection.

A 28-year-old woman with no history of vascular risk factors received bitemporal autologous fat injection (cosmetic surgery) under general anesthesia. Immediately following the injection, she became drowsy and developed expressive aphasia and right hemiparesis. National Institutes of Health Stroke Scale (NIHSS) was 16. Magnetic resonance imaging (MRI)-diffusion-weighted image (DWI) showed acute left temporo-parietal infarct. MR angiography (MRA) revealed occlusion of M1 segment of the left middle cerebral artery (MCA) [Figure 1]. She was treated with mannitol, hydrocortisone (containing alcohol), antiplatelet agents and hyperbaric oxygen therapy. Computerized tomography cerebral angiography(CTA) and MRA performed 1 week after the onset of symptoms showed recanalization of the left MCA [Figure 2]. Three weeks after discharge, she showed considerable neurologic recovery and her NIHSS score was 6.
Figure 1: (a) Axial T1-weighted images demonstrate no abnormal signal in bilateral temporo-parietal lobe. (b) Axial T2-weighted MR image shows high signal lesion in left temporo-partietal lobe. (c) Hyperintense on DWI images secondary to early cytotoxic edema in left temporo-parietal lobe indicate the left middle cerebral artery (MCA) infarction. (d) TOF MRA shows occlusion of the M1 segment of the left middle cerebral artery

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Figure 2: (a) Conventional noncontrast computed tomography (NCCT) demonstrates hypodensity of the left temporo-parietal lobe. (b-e) Volume rendered image demonstrates recanalization of the left middle cerebral artery. Hypointensity signal lesion on T1-weighted and high signal lesion on T2-weighted image shows encephalomalacia in left temporo-partietal lobe. (f) Contrast enhancement MRA shows recanalization of the left middle cerebral artery

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Autologous fat transplantation is widely used in cosmetic plastic surgery. Fat is injected into the periocular area, paranasal area, glabellar area, forehead area, nasolabial folds, lower lip and chin. [4],[5],[6] In our case, the patient underwent fat injection into the bilateral temporal area to repair a soft tissue defect. In our patient, the temporal relation between the surgery and the event suggests that the acute ischemic stroke was due to fat embolism. CFE as a complication of autologous fat injection is extremely rare and only a few cases have been reported. [4],[5],[6] These cases serve as a warning to the cosmetic plastic and ophthalmic surgeons that they should be very careful to exert minimal force while injecting fat in the tissues.

 
 » References Top

1.Russell GV Jr, Kirk PG, Biddinger P. Fat embolism syndrome from an isolated humerus fracture. J Orthop Trauma 1997;11:141-4.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Johnson MJ, Lucas GL. Fat embolism syndrome. Orthopedics 1996;19:41-8.  Back to cited text no. 2
[PUBMED]    
3.Amigoni A, Corner P, Zanella F, Pettenazzo A. Successful use of inhaled nitric oxide in a child with fat embolism syndrome. J Trauma 2010;68:E80-2.  Back to cited text no. 3
[PUBMED]    
4.Dreizen NG, Framm L. Sudden unilateral visual loss after autologous fat injection into the glabellar area. Am J Ophthalmol 1989;107:85-7.  Back to cited text no. 4
[PUBMED]    
5.Egido JA, Arroyo R, Marcos A, Jiménez-Alfaro I. Middle cerebral artery embolism and unilateral visual loss after autologous fat injection into the glabellar area. Stroke 1993;24:615-6.  Back to cited text no. 5
    
6.Feinendegen DL, Baumgartner RW, Schroth G, Mattle HP, Tschopp H. Middle cerebral artery occlusion and ocular fat embolism after autologous fat injection in the face. J Neurol 1998;245:53-4.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  


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