Cerebral Fat Embolism Syndrome in a Patient With an Aortic Dissection and Orthopedic Injuries: A Case Report

Traumatic brain injury is a significant cause of morbidity and mortality in adults and can be associated with severe secondary complications, including post-traumatic cerebral infarction. One potential cause of post-traumatic cerebral infarction is cerebral fat embolism syndrome (FES). We present a case in which a male in his twenties was involved in a motorcycle collision with a truck. He sustained numerous injuries, including bilateral femur fractures, left acetabular, open left tibial and fibular fractures, and a type A aortic dissection. Before orthopedic fixation, his Glasgow Coma Score (GCS) was 10. Following open reduction and internal fixation, his GCS was noted to be 4, with a stable computed tomography scan of the head. The differential included embolic strokes related to his dissection, an unrecognized cervical spine injury, and cerebral FES. Stat magnetic resonance imaging of the head demonstrated a starfield pattern of restricted diffusion consistent with cerebral FES. An intracranial pressure (ICP) monitor was placed, and his ICP acutely spiked to over 100 mmHg despite maximal medical management. This case highlights several key learning points, namely, that cerebral FES should remain in the mind of any physician treating high-energy multisystem traumas. While it is a rare syndrome, its effects can lead to significant morbidity and mortality as treatment is controversial and can conflict with the treatment of other systemic injuries. Further research into prevention and treatment is warranted to continue optimizing outcomes following cerebral FES.