Late recovery in cerebral fat embolism
A 28 year old male presented with RTA and sustained closed fracture of the right femur. He was admitted in the evening at 6 pm and was planned for interlocking nailing the following day. He had no other injuries and was fully conscious at admission. Next day morning at 7 am, patient was found to be drowsy and CT of the brain was carried out, which was reported to be normal. The pulse rate was 114/min, blood pressure was 122/84 mmHg with an oxygen saturation of 86% at room air. Within 3 h, consciousness of patient rapidly deteriorated with the GCS falling to 7/15 and he required intubation and ventilation to maintain oxygen saturation. Clinically, a diagnosis of fat embolism syndrome was made after ruling out head injury, hypotension, electrolyte and metabolic disturbances. The fracture was then stabilized by an external fixator on the 2nd day after injury. Chest X-ray, was initially normal and showed bilateral diffuse haziness after 2 days []. Since consciousness did not improve even after 6 days, MRI of the brain was done, which confirmed cerebral fat embolism []. As there was continued requirement of mechanical ventilation with positive end expiratory pressure, tracheostomy was done. Mechanical ventilation was continued for 5 weeks until he regained consciousness with the GCS improving to 11/15. Gradual weaning was carried out with T-piece and ventilation support was discontinued at 6 weeks. External fixator removal and interlocking nailing was carried out for fracture femur at 8 weeks since injury. Neurologically, patient had poor cognition and spasticity initially, which gradually improved and the patient returned to his original job. At 6 months, postinjury the patient had good neurological recovery (GOS) and normal cognition (MMSE).