BMJ Case Reports 2018; doi:10.1136/bcr-2018-225261
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Cerebral fat embolism syndrome (FES): similar cases with different outcomes

  1. Jibanananda Satpathy2
  1. 1Howard Hughes Medical Institute, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
  2. 2Department of Orthopaedics, Virginia Commonwealth University, Glen Allen, Virginia, USA
  1. Correspondence to Alexis Jorgensen, blightaa{at}
  • Accepted 16 September 2018
  • Published 8 October 2018


Fat embolism syndrome (FES) is a rare multisystem, clinical syndrome occurring in 0.9%–2.2% of long-bone fractures. The severity of FES can vary from subclinical with mild respiratory changes and haematological aberrations to a fulminant state characterised by sudden onset of severe respiratory and neurological impairment. Here we present two patients with cerebral FES secondary to femur fracture. Both patients exhibited profound neurological impairment with varied outcomes. Our cases highlight the importance of a high clinical suspicion of FES in patients with long-bone fractures and neurological deterioration. We recommend early plate osteosynthesis to prevent additional emboli in patients with FES and situational placement of intracranial pressure monitoring. Finally, cerebral FES has low mortality even in a patient with tentorial herniation and fixed, dilated pupils.


  • Contributors AJ, AB and JS contributed in equal parts to the planning, conduct and reporting of the work described in the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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