Background: Cerebral fat embolism (CFE) is a subtype of fat embolism syndrome which tends to cause ischemic cerebral infarction. Fat embolism in the cerebral venous system have not been reported. We hereby present a rare case of fat embolus formed in the cerebral venous system 10 days after cosmetic surgery, and describe our management of this patient. Case presentation: A 26-year-old woman with the disturbance of consciousness and recurrent convulsions of the right upper extremity over a 21-h period was admitted to our hospital. The patient was initially diagnosed with haemorrhagic infarction, and cerebral venous thrombosis (CVT) was suspected based on computed tomography (CT). A diagnosis of CFE was confirmed based on surgical findings. Breast and hip augmentation performed 10 days ago was considered the underlying cause. Drug-induced hypothermia, low molecular weight heparin, atorvastatin, dexamethasone, piperacillin/tazobactam, valproic acid, and mannitol were applied. On hospital day 30, she was discharged with a Montreal Cognitive Assessment score of 25. Conclusions: Fat embolism can occur in the cerebral venous system, and may mimic CVT symptoms rather than CFE symptoms. Early identification of the nature of the embolus is essential. The use of heparin may prevent secondary thrombus formation, and accelerate fat embolus decomposition.

Objective To investigate the treatment strategies, efficacy and surgical indications of hypertensive thalamic hemorrhage.Methods A retrospective analysis of the clinical data of 137 cases with hypertensive thalamic hemorrhage (HTH) from January 2008 to January 2010 in West China Hospital of Sichuan University were performed to compare the efficacy and prognosis between surgical treatment group and conservative treatment group.Results Of the 137 patients, 62 patients underwent surgery and 75 patients receivedconservative treatment.In small hematoma group, 22 patients underwent borehole and drainage and 55 cases received conservative treatment.In large hematoma group, 40 patients received craniotomy to remove

目的分析自发性脑室内出血的病因、预后及影响预后的因素。方法 2009年1月—2010年1月四川大学华西医院神经外科收治69例自发性脑室内出血患者。所有患者均接受脑血管影像学检察[DSA或CT血管成像（CTA）、MR血管成像（MRA）],分析发病原因。69例患者中行内科保守治疗的有21例,腰椎穿刺持续引流的有9例,钻孔脑室外引流的有8例,开颅手术的有31例。随访4～9个月,采用改良Rankin量表（mRS）评估预后,分析影响预后的因素。结果 69例患者中原发性脑室内出血10例（14.5%）,继发性脑室内出血59例（85.5%）。既往有高血压史的65例（94.2%）。①10例原发性脑室内出血患者中,7例行DSA检查,3例行CTA/MRA检查。发现前交通动脉动脉瘤3例（其中1例有高血压史）,烟雾病1例,其余6例未见血管异常,但均有高血压史。59例继发性脑室内出血患者均接受CTA/MRA检查,未发现血管异常;其中10例行DSA检查,示小脑血管畸形1例（无高血压史）,其余患者均有高血压史。②无手术死亡病例。随访结果显示,mRS评分1～2分患者26例（37.7%）,3～4分19例（27.5%）,5分11例（15.9%）,死亡13例（18.8%）。③不同Graeb评分、GCS评分、脑实质内血肿量、出血部位及是否有梗阻性脑积水的患者预后不同（P＜0.05）。结论高血压是脑室内出血的主要原因;根据患者影响预后的临床评估情况制定合理的治疗方案,可以获得比较理想的预后。

Objective To define the clinical features, risk factors, etiology and prognosis of primary intraventricular hemorrhage (PIVH).Methods We prospectively formulated strict inclusive criteria and consecutively collected patients with diagnosis and treatment for PIVH in our hospital from September 2008 to October 2010.The clinical information, laboratory examinations, treatment and prognosis were analyzed.Results 47patients(27 males and 20 females, a ratio of 1.35: 1, with an average age of 52.6 ± 12.6 years old) were internalized in the study.The initial symptoms were headache in 24 cases, and disturbance of consciousness in 23 cases.The GCS score was 10.8 ± 2.6 and Graeb score was 5.8 ± 2.6.Combined obstructive hydrocephalus was found in 22 cases (47%).The diagnosis of moyamoya disease was confirmed in 12 patients (26%), while vascular malformations in 10 (21%) and aneurysm in 5( 11% ).The other 20 patients had unknown etiology (43%).Craniotomy was performed in 12 cases (26%), craniotomy combined EDAMS in 6(13%), EDAMS in 5(11% ), EDAMS combined with anastomosis in 1(2% ), ventricular drainage in 3(6% ), γ-knife in 8( 17% ), interventional therapy in 2(4% ), and conservative treatment in 10 patients (21%).All patients were followed - up for 6 months.7 cases of hospital mortality (15%) were found.31 patients (66%) got less than 3 points of mRS score at the end of the 6th month, and 9 patients ( 19% ) had greater than or equal to 3 points.After discharge there was no death.Conclusion PIVH is relatively rare in clinical practice.The age of onset for PIVH is relatively small.Moyamoya disease, AVM and aneurysm are ranked the top three causes, and hypertension is the most important risk factor.Through reasonable treatment, patients with PIVH could get better prognosis.Age, hypertension, diabetes, smoking history and admission GCS score could predict hospital mortality in varying degrees.