Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 59, Num. 3, 2011, pp. 474-475

Neurology India, Vol. 59, No. 3, May-June, 2011, pp. 474-475

Letter to Editor

Middle cerebral artery occlusion following autologous bitemporal fat injection

Jun Hu¹, Wei Chen², Yaguang Wu¹, Kangning Chen¹, Chunxia Luo¹, Yong Liang², Shugui Shi¹

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

Correspondence Address: Wei Chen Department of Radiology, Southwest Hospital, The Third Military Medical University, Chongqing China weichentmmu@hotmail.com

Date of Submission: 03-Jan-2011
Date of Decision: 03-Jan-2011
Date of Acceptance: 05-Jan-2011

Code Number: ni11138

PMID: 21743191

DOI: 10.4103/0028-3886.82749

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.

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.

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