Severe Traumatic Cerebral Fat Embolism Following Pelvic Fracture: A Case Report and Literature Review.

Abstract

Cerebral fat embolism (CFE) is a rare but severe complication of trauma, most often linked to long bone or pelvic fractures. We report a 71-year-old woman who developed severe CFE after a pelvic fracture, resulting in profound coma despite early supportive treatment. Brain MRI showed the characteristic "starfield" pattern confirming the diagnosis. A systematic literature review identified 12 cases of severe CFE (Glasgow Coma Scale [GCS] ≤9) reported since 2010, including the present case. Initial GCS ranged from 3 to 9, with lower scores generally predicting poorer outcomes. Although some patients recovered after deep coma, no consistent prognostic factor-such as GCS score, corticosteroid therapy, or timing of orthopedic surgery-was identified. However, early diagnosis, aggressive supportive management, and timely fracture fixation were repeatedly emphasized as essential to improving outcomes. Multidisciplinary care involving neurologists, intensivists, and orthopedic surgeons was critical. Severe CFE remains an uncommon but often devastating condition with high morbidity. Prognosis is variable but tends to correlate with initial neurological status. Greater awareness and early intervention may enhance survival and neurological recovery, while further studies are needed to clarify prognostic determinants and establish standardized management strategies.