E-045 A case of left internal carotid artery stroke due to fat embolism from novel cosmetic procedure: a case report

<h3></h3> A 28-year old woman was transferred to the emergency room following an acute change in mental status after liposuction and fat harvesting transfer into her gluteal region. She had a forced left-gaze, with right sided hemiplegia where the motor movements did not even respond to painful stimulation, and Babinski’s sign was positive on both the sides. The CT brain - stroke protocol scan was 5.5 h after the liposuction procedure showed a hypoattenuation signal in the left hemisphere and a hypodensity within the left Sylvian fissure, signs of grey-white matter differentiation, with 1mm MLS to the right. NIHSS on admission 26. 11 hours after the liposuction procedure, widespread petechiae developed on her chest, back, and arms. Brain magnetic resonance imaging (MRI) showed significant areas of hyperintense foci on T2-weighted and diffusion-weighted images in the deep gray matter, including the left lentiform nucleus, thalami, and bilateral caudate nuclei, and the left cortical area including the left frontal, temporal, and occipital lobes. The history of liposuction, the disturbance in consciousness, the petechial rashes on the skin, and the CT/MRI findings prompted a diagnosis of fat embolism. The black signal seen on the CT scan image was considered to be representative of a fat embolism, which had blocked the left Internal carotid artery. Large amounts of fat droplets had embolized to the distal arteries and the watershed area was uninvolved. Although aggressive therapeutic medical measures were performed, her condition deteriorated due to a combination of factors, including the development of cerebral herniation, pneumonia, acute renal insufficiency, and hepatic failure. She died of multi organ failure on the 13 day after the liposuction procedure. <h3>Disclosures</h3> <b>D. Raza:</b> None.