Aphasia following tibial fracture surgery: A case report

Fat embolism syndrome is a serious and potentially life-threatening complication associated with long bone fractures and orthopedic procedures. Cerebral fat embolism (CFE), a rare neurological manifestation of fat embolism syndrome, typically manifests with nonspecific encephalopathic symptoms. Isolated focal neurological deficits, such as aphasia, are highly uncommon and seldom reported. This case illustrates an atypical presentation of CFE characterized by acute, isolated aphasia to enhance clinical awareness and prompt recognition.

A 57-year-old male developed acute expressive aphasia 1 hour following intramedullary nailing of a tibial fracture, in the absence of respiratory distress, hemodynamic instability, or dermatologic abnormalities.

Brain magnetic resonance imaging revealed the characteristic "starfield" pattern, confirming the diagnosis of CFE based on clinical history and laboratory findings.

Management included comprehensive supportive care: supplemental oxygen, intravenous glucocorticoids, and subcutaneous low-molecular-weight heparin.

By the fourth postoperative day, his condition had stabilized. His language function improved gradually over the following days, and he was discharged 1 week after surgery, able to produce short sentences with occasional pauses.

This case highlights that CFE can present with isolated aphasia. Early magnetic resonance imaging utilizing diffusion-weighted imaging is essential to confirm the diagnosis. A high clinical suspicion for CFE must be maintained in any patient exhibiting acute neurological deficits following orthopedic surgery to ensure timely recognition and intervention.