Disclosures: Jason L. Kessler, MD: No financial relationships or conflicts of interest

Case Diagnosis: Multifocal cerebral infarcts secondary to fat embolisms in the setting of long-bone polytrauma.

Case Description or Program Description: A 57-year-old man presented as a Level 2 trauma with bilateral lower extremity deformities after being pinned by a vehicle. He was neurologically intact on presentation and underwent external fixation of left femoral and tibial shaft fractures. Post-op Stroke Code was called for significant encephalopathy and left arm weakness. Patient was noted to have a generalized response to stimuli and was cognitively equivalent to a minimally conscious state. Brain MRI revealed multiple punctate lesions concerning for fat embolisms involving the bilateral frontal, parietal, and occipital lobes. Echocardiogram revealed an intrapulmonary shunt, and an IVC filter was placed.

Setting: Metropolitan Level 1 Trauma Center.

Assessment/Results: Four days after the onset of encephalopathy, the patient made remarkable neurological recovery with bedside therapy, demonstrating mild cognitive and communication deficits and mild dysarthria. His neurological recovery continued after admission to acute inpatient rehab. The patient was discharged from the speech-language service with only mild working memory impairments two weeks after the initial appearance of encephalopathy.

Discussion (relevance): Previous literature on cerebral fat embolisms report neurological recovery three weeks to four months after the initial insult, not days as was seen in this patient. Besides early bedside cognitive therapy while in the ICU, it is unclear how this patient’s recovery advanced so rapidly compared to other cases. Furthermore, there is a lack of knowledge in the rehab community regarding specific rehabilitation guidelines for cerebral fat embolisms, especially the timing and duration for therapy.

Conclusions: A prospective community-wide analysis of trauma patients complicated by fat embolisms would be beneficial for identifying prognostic factors for neurological recovery and for outlining treatment guidelines to optimize the rehab potential for these patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/time-really-is-brain-rapid-cognitive-recovery-in-a-patient-with-cerebral-fat-embolism-a-case-report/