Disclosures: Alvin Ng, MD: No financial relationships or conflicts of interest

Case Diagnosis: 21-year-old male with cerebral fat embolism after motor vehicle accident

Case Description: 21-year-old male who presented with a left tibia and fibula fracture status post motor vehicle accident, with initial Glasgow Coma Scale of 15. He underwent open reduction internal fixation with intramedullary nailing with orthopedic surgery. Post surgical hospital course was complicated by altered mental status, seizure-like activity, fever, thrombocytopenia, and respiratory failure requiring intubation. Brain MRI showed a starfield pattern of punctate areas of restricted diffusion widely dispersed through the brain, with etiology likely secondary to cerebral fat embolism syndrome (CFES).

Setting: Acute Inpatient Rehabilitation FacilityAssessment/

Results: On arrival to acute rehabilitation, he was nonverbal, had minimal extremity movement, required total assistance with therapies, and was level 4 on the Rancho Los Amigos scale (RLAS). Amantadine 100mg daily was started on day 4 of inpatient rehabilitation (21 days since accident and surgery), and a rapid improvement in his mental status was observed. By day 10, he was conversant, engaging in conversation with improved attention and short term memory, minimal-moderate assistance with transfers, mobility, and ADLs, and level 6 on RLAS. At time of discharge from inpatient rehabilitation, he was at a contact-guard to minimal assistance level for mobility and ADLs. Outpatient follow up 2 months after the initial accident reported significant improvements with minimal neurologic sequelae and he has resumed work.

Discussion: CFES is a rare complication that occurs most commonly after major trauma or long-bone fractures. Diagnosis is clinical with support from neuroimaging, and treatment is mainly supportive. Limited studies have evaluated long-term follow up of CFES, but with appropriate medical care and rehabilitation, good outcomes can be achieved for most patients.

Conclusion: We present and highlight the recovery and rehabilitation process of a patient with CFES.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cerebral-fat-embolism-syndrome-a-case-report/