فهرست نشریات علمی دسترسی آزاد ایران

Objective: Cerebral fat embolism (CFE) is a rare but potentially life-threatening complication oflong-bone fractures. It poses a significant diagnostic challenge due to its heterogeneous clinicalpresentation and frequently normal findings on early investigations. This report describes an atypicalcase of delayed-onset cerebral fat embolism characterized by neurological deterioration despiteunremarkable initial pulmonary and neurodiagnostic findings and the absence of an intracardiacshunt, which is commonly implicated in the passage of fat emboli into the arterial circulation. Afocused review of the literature is also provided to emphasize key diagnostic considerations andclinical implications.Case Presentation: A 20-year-old male presented following a road traffic accident with a rightsubtrochanteric femur fracture. The patient was neurologically intact and hemodynamicallystable at admission. Forty-eight hours later, he developed acute respiratory distress followedby progressive neurological deterioration, culminating in coma and the need for mechanicalventilation. Initial investigations, including computed tomography of the brain (CT), computedtomography pulmonary angiography (CTPA), electroencephalography (EEG), routine laboratorytests, and transthoracic echocardiography (TTE), were unremarkable, with no evidence of a rightto-left intracardiac shunt. Persistent unexplained neurological impairment prompted magneticresonance imaging of the brain (MRI) on day five, which demonstrated multiple bilateral punctatediffusion-restricted lesions in the subcortical and deep white matter, forming the characteristicstarfield pattern consistent with cerebral fat embolism. The patient was managed with supportivecritical care, systemic corticosteroids, and rehabilitation, resulting in gradual neurological recoveryand a favorable functional outcome.Conclusion: This case highlights the diagnostic challenge posed by CFE. It emphasizes theimportance of maintaining a high index of suspicion in trauma patients who develop unexplainedneurological symptoms, particularly when initial imaging is inconclusive. Prompt MRI evaluationand timely life-supportive management are essential for better outcomes