Fat Embolism Syndrome With Cerebral Involvement: An Underrecognized Complication of Long Bone Fractures

Abstract

Fat embolism syndrome (FES) occurs when fat particles are aberrantly distributed into the microcirculation, and it often manifests as either hypoxemia, neurological deficit, or petechial rash. Although cases have been reported in the literature since the twentieth century, no formal diagnostic criteria have been universally adopted, and FES remains a diagnostic challenge. We present a unique case of FES from a long bone fracture, leading to pulmonary embolism with paradoxical arterial embolization and cerebral infarction, and provide a review of the related literature.

Early and Isolated Cerebral Fat Embolism in a Trauma Patient with Multiple Fracture - A Case Report

“…Fat embolism syndrome is a clinical diagnosis and is caused by the release of fat droplets into the systemic circulation after conditions or procedures such as long bone or pelvic fractures, orthopedic surgery or other interventions [1][2][3][4][5]. The pathophysiology of FES in unknows, but different mechanisms have been suggested [6].…”

“…FES manifestations can vary from mild cognitive changes to coma and even cerebral edema and brain death. The exact incidence of FES stemming from traumatic long bone injuries varies in literature, from 0.9% when clinical criteria are used for diagnosis to 29% in post-mortem autopsies [1]. Cerebral fat embolism (CFE) has been described in about 10% of FES cases based on clinical criteria, but the true incidence is also unclear due to the absence of definitive diagnostic testing [2].…”