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| Cerebral fat embolism syndrome is a documented, if not rare, complication following long bone fractures, fixation of long-bone fractures, and total joint arthroplasty. An 18 year-old female developed clinical signs of cerebral fat embolism syndrome following closed reduction of a hip dislocation and closed intermedullary rodding of an ipsilateral mid-shaft femur fracture. Immediately post-operatively the patient was obtunded and required ventilatory support. An initial MRI of the brain revealed characteristic diffuse cerebral and cerebellar infarcts. An echocardiogram was obtained and showed no evidence of cardiac abnormality, left-to-right shunt, or patent foramen ovale. The patient progressively improved throughout her hospital stay and regained full cognition prior to discharge. A second MRI, performed twenty-one days after the inital study, demonstrated marked improvement in the cerebral lesions and complete resolution of the cerebellar lesions. This is a unique case of paradoxical cerebral fat embolism following intramedullary rodding of the femur in the absence of cardiac abnormalities causing a left-to-right shunt, such as a patent foramen ovale. |
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Figures 1a and 1b: Initial Emergency Room radiographs depicting inferior hip dislocation and ipsilateral femoral shaft fracture. |
| Figures 2a and 2b: Pre-reduction CT of the hip joint showing inferior hip dislocation. |
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| Figure 3: Post-operative radiograph of the femur with antegrade intramedullary rod. |
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Figure 4: Post-reduction CT of the hip joint demonstrating the femoral head reduced within the acetabulum. |
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Figures 5a, 5b, and 5c: Initial MRI exam of the brain showing diffuse cerebral (5a and 5b - upper left and right) and cerebellar (5c - left) infarcts secondary to Fat Embolism Syndrome. This study was performed post-operatively after the patient became obtunded. |
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| Figures 6a, 6b, and 6c: Follow-up MRI exam of the brain showing marked improvement of the cerebral lesions (6a and 6b - upper left and right) and complete resolution of the cerebellar lesions (6c - right). This was performed 21 days after the initial MRI, and after the patient's clinical symptoms had subsided. |
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Figures 7a, 7b, and 7c: Echocardiogram images demonstrating normal cardiac anatomy and no left-to-right shunt. |