Cerebral fat embolism syndrome (FES): similar cases with different outcomes

Abstract

Fat embolism syndrome (FES) is a rare multisystem, clinical syndrome occurring in 0.9%–2.2% of long-bone fractures. The severity of FES can vary from subclinical with mild respiratory changes and haematological aberrations to a fulminant state characterised by sudden onset of severe respiratory and neurological impairment. Here we present two patients with cerebral FES secondary to femur fracture. Both patients exhibited profound neurological impairment with varied outcomes. Our cases highlight the importance of a high clinical suspicion of FES in patients with long-bone fractures and neurological deterioration. We recommend early plate osteosynthesis to prevent additional emboli in patients with FES and situational placement of intracranial pressure monitoring. Finally, cerebral FES has low mortality even in a patient with tentorial herniation and fixed, dilated pupils.

Do you know the diagnostic importance of susceptibility‐weighted imaging on MRI for patients with cerebral fat embolism?

“…We performed a filtered search for “within 5 years” and “case report” using the keywords “cerebral fat embolism” and “MRI” in a PubMed search. Of 42 cases of cerebral fat embolism included in 39 papers, 3–41 we analyzed 33 cases 3–17,19–26,28–30,32,34,37,39,40 after excluding the following: (1) cases not available ( n = 2), 27,35 (2) not a case report ( n = 1), 33 (3) not in English ( n = 1), 18 (4) not cerebral fat embolism ( n = 3), 36,38,41 (5) diagnosis obtained by CT instead of MRI ( n = 1), 32 and (6) MRI contraindicated due to a magnetic implant ( n = 1) 31 . Of the 33 cases, SWI of the brain was acquired in 10 cases 4,5,10,12,17,25,34,36,37,41 …”

Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports

“…The recent literature highlights how FES has gathered recognition thanks to the clinical descriptions in case reports and case series [18][19][20][21][22]. However, the frequency of the syndrome is too low to permit any conclusions to be drawn from the individual studies reported in literature.…”