Death from bone marrow and fat embolism is rare and, obviously, after minor trauma exceedingly rare, although there will undoubtedly be many cases that have not been published and many others that will have gone unrecognised. Deep venous thrombosis and pulmonary embolism after aircraft flights were thought to be rare but, with publicity, emergency departments close to major airports reported that they have seen such patients regularly over many years. This is known as the finder effect. Nevertheless, the odds against death from minor trauma are, of course, extremely large. The examination of many millions, or even billions, of cases of minor injury would in all likelihood not find a single death from such a cause and so such a mechanism may be readily discounted by those who argue from epidemiological and statistical data . . . In fact, it is the only argument open to those who discount a link between trauma and the development of multiple areas of sclerosis.
However, the cause of the lady’s death following the forearm bruising covered by the Daily Telegraph was established beyond question, simply because droplets of fat were present in the lungs and in other organs, including the brain, at post-mortem examination.
As the level of trauma increases, so does the likelihood of fat embolism. Fat embolism can also provide a solution to a puzzling feature of multiple sclerosis; it affects twice as many women as men and women generally have twice the body fat content of men. Each feature of fat embolism is subject to a normal or Gaussian distribution, from the release of fat into the circulation, to trapping in the lungs, to finally sustaining damage in the nervous system. In other words, some people will be more likely to have such an event, others very unlikely, with most of us having an intermediate risk.
(Reference: James, P.B. Oxygen and the Brain: The Journey of Our Lifetime. North Palm Beach: Best Publishing Company; 2014.)
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