Tip-of-the-Basilar Stroke secondary to Fat Embolization after Hip Arthroplasty (P4.3-006)

Objective: We present a rare case of distal basilar artery stroke from fat embolism after right hip arthroplasty, who underwent emergent thrombectomy with recanalization of the basilar artery. Background: Fat embolism syndrome (FES) is a known complication of long bone and pelvic fractures. The classic triad consists of hypoxemia, petechial rash, and altered mentation, typically developing within the first 24–72 hours after injury. CFE is a rare cause of embolic stroke. MRI brain shows a “star-field pattern” acutely, indicative of scattered punctate embolic infarcts without the visible emboli; this correlates to the degree of clinical impairment. Very rarely, CFE can cause intracranial vessel occlusions causing large territorial infarcts. CT head demonstrates a “hypodense artery sign” which indicates the presence of a macroscopic fat embolus, as opposed to the hyperdense artery sign seen with acute thrombosis. Design/Methods: Case Report Results: This is a 70-year-old female who was found unresponsive, hypotensive, and hypoxic after a right total hip arthroplasty necessitating re-intubation. She was comatose and had absent cranial nerve reflexes except for intact cough reflex. She had an extensor response in her upper extremities and triple flexion of her lower extremities to stimuli. Brain CT demonstrated a hypodensity of the basilar artery suggestive of a fat embolism. She was not administered thrombolytic therapy due to major surgery. She underwent emergent thrombectomy with successful revascularization of her basilar artery. She was also found to have a 1.5 cm patent foramen ovale. Unfortunately, due to lack of clinical improvement, her family decided to withdraw care. Conclusions: This is a rare case of an intracranial vessel occlusion caused by a fat embolism that was successfully retrieved by thrombectomy. Mechanical thrombectomy can be an option in patients with fat embolism causing large vessel occlusion. Similar to atheroembolic conditions, these patients require timely re-canalization to improve neurological outcome. Disclosure: Dr. Gopal has nothing to disclose. Dr. Thakur has nothing to disclose. Dr. Lakhani has nothing to disclose. Dr. Hinduja has nothing to disclose.