Decompressive Hemicraniectomy After Cerebral Fat Embolism

TL;DR

A 21-year-old man with cerebral fat embolism after a motorcycle accident recovered well after decompressive hemicraniectomy.

Contribution

This case highlights the potential effectiveness of decompressive hemicraniectomy in treating severe cerebral fat embolism.

Findings

The patient underwent decompressive hemicraniectomy and returned to his neurological baseline seven months later.

Prompt recognition and treatment of elevated intracranial pressure led to a favorable recovery.

Decompressive hemicraniectomy may offer promising outcomes in severe cerebral fat embolism cases.

Abstract

Fat embolism syndrome is a common occurrence after orthopedic trauma and surgery. Cerebral fat embolism (CFE) may arise after fat globules enter the arterial circulation. The neurological manifestations of CFE vary and generally carries a favorable outcome. A small number of reports exist regarding patients with CFE who experienced severe neurological deficits and significant edema on radiographic studies, and subsequently underwent decompressive hemicraniectomy (DHC), some of which had full neurological recoveries. Here, we present the case of a 21-year-old male who presented after a motorcycle accident with multiple orthopedic injuries, who after fixation did not awake from anesthesia. The patient was ultimately found to have cerebral fat emboli, and developed significant edema and swelling. The patient underwent DHC with subsequent cranioplasty and returned to his neurological baseline seven months after his initial injury. DHC for CFE has been described in a few cases with some patients have had substantive recoveries, including the present case. This case emphasizes the importance of promptly recognizing and reversing elevated intracranial pressures and the possibility of promising recoveries.

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