Cerebral fat embolism: Report of two cases and literature review

Abstract

Fat embolism syndrome was first described in 1861 and several theories have emerged about its physiopathology and criteria without reaching a consensus. This case report will add to the knowledge and awareness of an entity that can be easily unrecognized when not suspected. Furthermore, clinical evidence is scarce and each case must be evaluated individually according to the context and diagnostic work up. Diagnosis has been based on clinical grounds and require a high index of suspicion in patients who had a decline on their respiratory and/or neurological condition. In addition, the context and timing of the event is key in a proper diagnosis as well as ruling out differential diagnoses. Two cases of high energy trauma secondary to traffic accidents are presented here. During ICU stay these patients presented neurological deterioration not attributable to any other cause. There were other systemic symptoms and signs that lead to the diagnosis of fat embolism. Both cases received respiratory support in the Intensive Care Unit, however clinical course and outcomes were completely different. The divergent outcomes for these two cases emphasize the importance of a timely diagnosis in order to guide interventions and counsel family. We highlight the fact that despite a slow or uncertain clinical course there is a potential for good recovery, hence a premature prognosis can mislead interventions and family. Our primary goal is to raise awareness of this entity in the trauma population and the importance of further research aimed to improve the clinical evidence for treatment and outcomes.