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Case Reports
. 2024 Sep 13:54:101109.
doi: 10.1016/j.tcr.2024.101109. eCollection 2024 Dec.

Rapid-onset cerebral fat embolism syndrome leading to brain death: A case report

Jordyn D Williams  1 , Jonathan D Gates  2   3   1 , Alfred J Croteau  2   3   1
Affiliations
Case Reports

Rapid-onset cerebral fat embolism syndrome leading to brain death: A case report

Jordyn D Williams et al. Trauma Case Rep. .

Abstract

Background: Fat Embolism Syndrome (FES) is a rare clinical phenomenon attributed to fat droplet embolization and subsequent multisystem organ failure, typically following traumatic orthopedic injury. It classically presents with hypoxemia, transient neurologic deficits, and skin changes that appear a day or more after the initial insult. Its exact mechanism remains unclear, although the mechanical obstruction of capillaries or production of toxic intermediaries following fat hydrolysis and extravasation of marrow have been described. Here, we present a new case of cerebral FES with symptom onset within 12 h and brain death within 48 h.

Patient: A 22-year-old male with multiple orthopedic fractures developed Fat Embolism Syndrome with neurological and respiratory symptoms within 12 h of presentation.

Results: The patient developed intractable cerebral edema and hypernatremia leading to brain death within 48 h.

Conclusion: Diffuse fat emboli can lead to rapid development of fatal cerebral edema even in the absence of anatomical shunts. MRI is the superior modality to detect FES and should be pursued early in patients with risk factors or clinical signs of neurologic involvement.

Keywords: Anatomical shunts; Brain death; Fat embolism syndrome; Orthopedics; Trauma.

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Conflict of interest statement

Nothing to declare.

Figures

Fig. 1
Fig. 1
Plain radiographs showing (left) a left closed midshaft femur fracture and (right) a right grade 3 open tibia/fibular fracture.
Fig. 2
Fig. 2
An axial DWI (Diffusion-Weighted Imaging) MR showing multiple foci of restricted diffusion scattered throughout the brain parenchyma.
Fig. 3
Fig. 3
A non-contrast head CT showing diffuse loss of gray-white matter differentiation and effacement of the basilar cisterns.
See this image and copyright information in PMC

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