Asian Journal of Medical Research and Case Reports

Background: Fat embolism syndrome (FES) is a rare but potentially serious complication of long-bone fractures. Cerebral fat embolism (CFE) is an uncommon and severe neurological manifestation that may occur with or without prominent pulmonary involvement and can be difficult to diagnose because its clinical presentation may mimic other acute neurological conditions.

Case Presentation: A 23-year-old male presented with a closed, displaced left femoral shaft fracture following blunt trauma during a volleyball incident. Approximately 18 hours after the injury, he developed nausea, vomiting, generalised tonic posturing, frothing, and severe impairment of consciousness, with a Glasgow Coma Scale (GCS) score of 6/15. He was intubated and mechanically ventilated because of neurological deterioration and respiratory compromise. Computed tomography pulmonary angiography (CTPA) showed diffuse ground-glass opacities without evidence of macro-pulmonary thromboembolism. Brain MRI demonstrated multiple acute lesions involving the bilateral centrum semiovale and basal ganglia, consistent with cerebral microvascular embolic injury. The patient also developed a marked elevation in C-reactive protein and a transient reduction in platelet count. No petechial rash was observed, and echocardiography showed no intracardiac shunt.

Management and Outcome: The patient was managed in the neuro-intensive care unit with lung-protective mechanical ventilation, intravenous antiepileptic therapy with sodium valproate and levetiracetam, corticosteroid therapy with hydrocortisone, and supportive critical care. Definitive open reduction and internal fixation of the femoral fracture was subsequently performed. The patient showed progressive neurological and respiratory improvement, was successfully extubated on day 4, and achieved complete neurological recovery. He was discharged with oral antiepileptic therapy and a planned rehabilitation programme.

Conclusion: CFE should be considered in patients who develop unexplained neurological deterioration, seizures, or coma following long-bone fractures, even in the absence of petechial rash or intracardiac shunting. Early recognition, appropriate neuroimaging, seizure control, respiratory support, and multidisciplinary management may contribute to favourable neurological outcomes.