Disclosures: Vaibhav Batheja, DO: No financial relationships or conflicts of interest

Case Diagnosis: Polytrauma patient developing Cerebral Fat embolism(CFE) from paradoxical event

Case Description: An otherwise healthy 26-year-old male was struck by a motor vehicle while riding a bicycle and suffered a comminuted left tibia and fibula fracture, with initial head imaging being unremarkable. On Day 2, prior to surgical fixation the patient developed altered mental status, and respiratory failure requiring rapid intubation. A comprehensive work-up with MRI showed the patient had multiple bilateral CFE, in the supra and infratentorial regions. Subsequent echocardiogram demonstrated the patient had a patent foramen ovale, resulting in paradoxical emboli. Patient was placed in external fixator and transferred to inpatient rehabilitation. Cognitively, he was alert and oriented, but with anosognosia and impairments in memory and coordination. Upon discharge from rehabilitation, he demonstrated marked improvements in coordination and cognition with progression to modified independence in ambulation and self-care tasks.

Setting: Inpatient Rehabilitation at an Academic HospitalAssessment/

Results: This case report highlights that timely diagnosis of CFE from long bone fractures, followed by intensive therapy can lead to dramatic clinical improvement.

Discussion: CFE is a rare complication of long bone fractures, which can present with neurological changes in a patient most commonly from a right to left cardiac shunt or pulmonary arteriovenous malformations. Given that CFE typically present between 12 to 96 hours after injury, the likelihood of patients being under the care of physiatrists is present. Physiatrists should be cognizant of this presentation, as early diagnosis and treatment with adequate oxygenation to prevent secondary brain damage followed by intensive rehabilitation, can lead to significant neurological recovery.

Conclusion: CFE, while rare, should be judiciously considered in polytrauma patients with clinical change in neurological status in the absence of head injury. Rapid intensive treatment to prevent secondary brain damage from hypoxemia, followed by intensive rehabilitation can lead to a reversal of deficits and marked clinical improvement.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cerebral-fat-embolism-from-a-long-bone-fracture-a-case-report/