Log In

Forgot Password?

OR

Not a member? Continue as a nonmember.

Become a Member

By becoming a member of the AAN, you can receive exclusive information to help you at every stage of your career. Benefits include:

Join Now See All Benefits

Loading... please wait

Abstract Details

Highlighting Paradoxical Cerebral Fat Embolism: Potentially Fatal Sequela of Road Traffic Accident.
Neuro Trauma and Critical Care
P9 - Poster Session 9 (5:30 PM-6:30 PM)
1-006

Fat embolism syndrome (FES) is a triad of petechial rash, deteriorating mental status and progressive respiratory insufficiency, caused by embolization of fat particles into multiple organs. When neurological signs and symptoms predominate, cerebral fat embolism must be kept high in differential. It usually occurs within 24–72 hours of trauma with traumatic long-bone fractures or an orthopedic surgery. Its incidence ranges from 0.9-11% with a mean mortality rate around 10%. Pathophysiology involves either paradoxical embolism or lung filtration. 

We present a case of severe neurologic decline secondary to paradoxical cerebral fat embolism (CFE) following bilateral femur fractures after a road traffic accident (RTA).

Case report. 

17-year-old, boy with type 1 diabetes mellitus, presents after having a RTA resulting in bilateral femoral and L1 spine burst fractures with mesenteric contusions. On scene, he had a self-resolving loss of consciousness followed by GCS 14 in ER with some confusion and unremarkable CT head. Had gradual improvement throughout the day, being more conversant within 24 hours. Later, he suddenly developed paroxysmal sympathetic hyperactivity with GCS 7 and normal CT head, followed 2 hours later by episodes concerning for decorticate posturing, requiring Lorazepam and Levetiracetam load with maintenance. He underwent internal fixation and intubated subsequently the next day. MRI brain obtained within 48 hours showed “starfield pattern” on DWI sequence, characteristic for CFE. Echocardiography showed patent foramen ovale. Mental status improved gradually over two-weeks with ability to follow simple commands. Managed supportively, underwent tracheostomy and peg-tube placement and transferred to a rehab hospital. 

FES complicated with CFE is an uncommon, but fatal sequela of RTA. A missed diagnosis of neurologic dysfunction due to CFE may inappropriately guide assessment of patient’s prognosis and subsequently decisions regarding escalation or even withdrawal of care. 

Authors/Disclosures
Maria Shoaib, MD (Peace Health Southwest)
PRESENTER
Dr. Shoaib has nothing to disclose.
Ahmer Asif, MD Dr. Asif has nothing to disclose.
Evan Fields, MD (Ou health) Dr. Fields has nothing to disclose.
Noor Mahmoud, MD (University of Oklahoma Health Sciences Center) Dr. Mahmoud has nothing to disclose.
Nidhiben A. Anadani, MD (University Of Oklahoma Health Science Center) Dr. Anadani has nothing to disclose.