Cerebral Fat Embolism Syndrome an Uncommon Form of Coma (P5.125)

Objective: To describe a case of reversible coma from cerebral fat embolism following orthopedic procedure. Background: Cerebral fat embolism syndrome is a relatively uncommon cause of coma usually observed within 12-72 hours of fracture involving the long bones and various orthopedic procedures. It is characterized by petechial rash, respiratory distress and varying degree of neurological deficits. Brain MRI and MR spectroscopy can aid in its diagnosis and prognosis. Methods: Case report Results: A 65-year old lady gradually became comatose despite aggressive resuscitation for hypotension and hypoxia, few hours following elective hip arthroplasty. She had roving eye movements, generalized hyperreflexia and bilateral extensor plantar response. MRI study of the brain showed extensive areas of hyperintensities involving the cortex, subcortical white matter, basal ganglia, brain stem and bilateral cerebellum on T2-weighted and fluid attenuated inversion recovery (FLAIR) sequences. These lesions were hyperintense on the diffusion images and majority of these lesions demonstrated restricted diffusion on the corresponding ADC maps. MR spectroscopy showed elevated lipid and lactate peaks in the areas of involvement. Transthoracic echocardiography failed to reveal a right to left shunt. A diagnosis of cerebral fat embolism was made based on the clinical and imaging findings. Her neurological condition remained unchanged upon discharge 4 weeks later. Over the next three months she made gradual recovery and could follow simple commands, but required assistance for activities of daily living. Conclusion: Despite an initial poor clinical picture, complete recovery has been reported upto 6 months after the initial insult. In patients with coma/abnormal posture, good outcome (intact or mild disability) has been observed in 57[percnt]. Our patient was comatose but continued to improve at 3 months. Clinicians should be aware of this rare cause of coma that has a fairly reasonable chance of delayed recovery. Study Supported by:None Disclosure: Dr. Al-salaimeh has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Hinduja has nothing to disclose.