October 2020 Critical Care Case of the Month: Unexplained Encephalopathy Following Elective Plastic Surgery

Abstract

No abstract available. Manuscript truncated after 150 words. A 29-year-old woman with no significant medical history presents to the hospital due to progressive encephalopathy, 5 days after undergoing an elective abdominoplasty with abdominal liposuction and breast augmentation. She is somnolent on exam, and is hypoxic to ~60% saturation on room air. She is emergently intubated in the emergency department prior to being admitted to the MICU, and is started on broad-spectrum antibiotics and n-acetyl cysteine (NAC). She has evidence of acute liver failure but her initial work-up for acute liver failure is entirely unrevealing, and her liver function and hemodynamics improve without additional intervention over the initial 3 days of hospitalization. Unfortunately, her mental status does not improve. Despite weaning of all sedation, she shows limited signs of awareness. A lumbar puncture, CT of the head, and electroencephalogram (EEG) are performed and are unremarkable. What should be done next? 1. Brain magnetic resonance (MRI) imaging 2. Myelography 3. …

Keywords

• fat embolism
• fat embolism syndrome
• liposuction
• mri
• brain mri
• treatment
• corticosteroids
• mechanism
• symptoms
• review