Cerebral Fat Embolism After Traumatic Long-Bone Fracture: A Case Report

We here describe a rare case of a 26-year-old male patient, presenting to our hospital after a motorcycle-car accident for the surgical management of long-bone fractures to the tibia and femur and shoulder dislocation and undergoing orthopedic surgery, who postoperatively developed seizure, coma, and respiratory failure due to a cerebral fat embolism. After some hours after the surgery, a loss of consciousness was described by caregivers, and the ICU team was alerted, and the patient was admitted to ICU. Intracranial hemorrhage and stroke were subsequently excluded and, finally, a whole-body computed tomography angiography scan and head magnetic resonance imaging showed lesions consistent with cerebral fat embolism. Patent foramen ovale was then suspected by contrasted echocardiography. An early diagnosis helped to choose the correct management, with early tracheostomy, and to correctly interpret and manage hemodynamic dysregulations. Overall, the care provided lead to positive long-term outcomes, as the patient was discharged alive and successfully completed neurological rehabilitation, regaining many functional abilities. The initial management, diagnostic pathway, and ICU management are here described.