Post-trauma cerebral fat embolism: Case report

Abstract

Introduction. The incidence of fat embolism subsequent to long bone fractures ranges from 0.9% to 2.2% of cases. Symptoms typically manifest within 12 to 72 hours post-injury. Risk factors associated with the development of Fat Embolism Syndrome include youthful age, closed fractures, multiple fractures, and conservative management of long bone fractures. Case report. After a traffic accident, a 17-year-old male suffered chest and limb injuries, including bilateral pneumothorax, left lung contusion, fractures of the spine transverse processes in L1, L3, L4, a splenic rupture without capsule damage, and a left femoral body fracture. Initially conscious, he required sedation and intubation. Left pleural cavity drainage was conducted, traction was applied to the left femur. No response to stimuli, sporadic cough reflexes and spontaneous breaths were noted. The right pupil dilated, and a cerebral CT scan was performed, prompting decompression due to signs of cerebral edema. A fine petechial rash was observed, indicative of fat embolism. Subsequent CT scans revealed progressive cerebral changes, suggesting potential brainstem involvement. CTA ruled out thromboembolism, while MRI findings supported the diagnosis of fat embolization-induced alterations. Discussion. Cerebral fat embolism commonly exhibits deteriorating neurological status, respiratory symptoms, and petechial rashes. MRI stands as the cornerstone in differentiating between cerebral fat embolism and traumatic brain injury, guiding precise treatment approaches and prognostic assessments. Medications such as anticoagulants and corticosteroids therapy have been significantly linked to reduced mortality, even though a targeted treatment for this condition remains elusive. Notably, a similar case documented in the British Geriatrics Society journal underscores the significance of fat embolism syndrome, especially in patients with femoral neck fractures. Conclusions. Cerebral fat embolism from long bone fracture led to brain ischemia, swelling, brainstem involvement, and the patient’s death.