The intersection of cerebral fat embolism syndrome and traumatic brain injury: a literature review and case series

ABSTRACT

Objective

To review the historical, clinical, radiographic, and outcome characteristics of individuals diagnosed with an acquired brain injury (ABI) due to cerebral fat embolism syndrome (CFES) with and without features of traumatic brain injury (TBI)

Methods

A retrospective chart review of individuals with the diagnosis of CFES admitted to an ABI rehabilitation program. Cases were divided into two cohorts 1) individuals with evidence of classic features of CFES alone, and 2) individuals with evidence of CFES in conjunction with features of TBI.

Results

14 individuals were identified, seven individuals with diagnosis of CFES alone, and seven with CFES and TBI. Median initial GCS was 15 for the isolated CFES cohort and 8 for the dual diagnosis cohort (p =.006). There were clear qualitative differences in MRI findings with characteristic patterns between the two groups.

Conclusion

The diagnosis of CFES is an important consideration for individuals who have new neurologic impairment following a trauma, especially in cases where initial GCS was high. MRI has an important role in differentiating lesions of CFES from TBI and should be utilized for prognostication and management decisions. Individuals with neurologic injury secondary to CFES had good functional recovery outcomes as measured by Glasgow Outcome Scale.

KEYWORDS:

• Cerebral fat embolism syndrome
• fat embolism syndrome
• diffuse axonal injury
• magnetic resonance imaging
• fractures
• intensive care
• recovery
• traumatic brain injury
• outcomes
• orthopedics
• focal cortical contusion
• function

Article highlights

• Cerebral fat embolism syndrome should be considered in any person whom presents with initial GCS greater than 13, that then has a deterioration in cognition following long bone or pelvic fractures; recently received general anesthesia; or undergone intramedullary surgical manipulation.

• Individuals with cerebral fat embolism have good functional neurologic recovery outcomes, especially in comparison to individuals with diffuse axonal injury. Providers should use caution in providing a poor prognosis in clinical situations in which CFES is the primary diagnosis being considered.

• A pattern of hyperintense lesions for CFES exists as discrete foci (starfield pattern), that is inconsistent with DAI, demonstrated on acute DWI MRI sequence which resolves in a subacute/chronic period of follow up MRI.

• A pattern of hypointense lesions related to CFES that persist from the acute into the subacute/chronic time periods as demonstrated by T2* weighted imaging on MRI.

Acknowledgments

The authors would like to thank Dr. James Feinstein and Ms. Sarah Adleman for their assistance in the preparation of this manuscript.

Declaration of interest

The authors report no declarations of interest.