Journal of Emergency Practice and Trauma

When Bone Breaks the Brain: A Case of Cerebral Fat Embolism

Document Type : Case Report

Authors

Asif Dabeer Jafri 1
Rehana Ansari 2
Tanmoy Ghatak 3
Ratender Kumar Singh 4

1 Department of Emergency Medicine and Tele-ICU Service, Sanjay Gandhi Post Graduate Institute of Medical Sciences

2 Department of Anaesthesia and Critical Care, BRD Medical College, Gorakhpur, Uttar Pradesh, India

3 Department of Emergency Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences

4 Head of Department of Emergency Medicine, Telemedicine and Digital Health, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

https://doi.org/doi:10.34172/jept.2025.25
Abstract
Objective: Cerebral fat embolism (CFE) is a rare but potentially life-threatening complication of
long-bone fractures. It poses a significant diagnostic challenge due to its heterogeneous clinical
presentation and frequently normal findings on early investigations. This report describes an atypical
case of delayed-onset cerebral fat embolism characterized by neurological deterioration despite
unremarkable initial pulmonary and neurodiagnostic findings and the absence of an intracardiac
shunt, which is commonly implicated in the passage of fat emboli into the arterial circulation. A
focused review of the literature is also provided to emphasize key diagnostic considerations and
clinical implications.
Case Presentation: A 20-year-old male presented following a road traffic accident with a right
subtrochanteric femur fracture. The patient was neurologically intact and hemodynamically
stable at admission. Forty-eight hours later, he developed acute respiratory distress followed
by progressive neurological deterioration, culminating in coma and the need for mechanical
ventilation. Initial investigations, including computed tomography of the brain (CT), computed
tomography pulmonary angiography (CTPA), electroencephalography (EEG), routine laboratory
tests, and transthoracic echocardiography (TTE), were unremarkable, with no evidence of a rightto-left intracardiac shunt. Persistent unexplained neurological impairment prompted magnetic
resonance imaging of the brain (MRI) on day five, which demonstrated multiple bilateral punctate
diffusion-restricted lesions in the subcortical and deep white matter, forming the characteristic
starfield pattern consistent with cerebral fat embolism. The patient was managed with supportive
critical care, systemic corticosteroids, and rehabilitation, resulting in gradual neurological recovery
and a favorable functional outcome.
Conclusion: This case highlights the diagnostic challenge posed by CFE. It emphasizes the
importance of maintaining a high index of suspicion in trauma patients who develop unexplained
neurological symptoms, particularly when initial imaging is inconclusive. Prompt MRI evaluation
and timely life-supportive management are essential for better outcomes

Keywords

Fat Embolism
Femoral Fracture
Pulmonary Embolism
Traffic Accident
Subjects
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Journal of Emergency Practice and Trauma
Volume 10, Issue 2
July 2024
Pages 171-175

  • Receive Date 08 July 2025
  • Revise Date 03 February 2026
  • Accept Date 25 October 2026

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