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Abstract
We are to report a case of cerebral fat embolism for presenting with unconsciousness without any respiratory dysfunction after intramedullary nailing for femur and tibia fractures. A sixteen-year-old boy was involved in motorcycle accident. His consciousness was alert. He had closed shaft fractures of left femur and left tibia and underwent standard femoral and tibial nail insertions. During the operation, there was no change of vital signs and saturation of oxygen. The consciousness was stuporous after the surgery. The brain CT was normal, but multiple high-signal intensity lesions in T2-weighted and diffusion-weighted images were found at bilateral cerebral hemispheres, corpus callosum, and pons. He woke up on postoperative day 12 and recovered to speak fluently without any neurological deficits at 3 months later. MR image should be recommended if the patient is not neurologically stable after the surgery for lone-bone fractures.
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FIGURE 1.
Simple radiographs of the left leg. Shaft fracture and dislocation (A) and postoperative intramedullary nailing (B) on the left femur. Left tibial and fibular fractures (C) and intramedullary nailing on the tibia (D).
FIGURE 2.
Computed tomography immediate after the orthopedic surgery. No abnormal density was visualized in the brain parenchyme.
FIGURE 3.
Magnetic resonance images at the postoperative 3rd day. Multiple high signal abnormalities in the pons, the splenium of the corpus callosum, the periventricular deep white matter, and the cerebral cortex on the diffusion-weighted images (top row), T2-weighted images (second row), and fluid attenuated inversion recovery images (third row). The abnormalities were not definitely visualized on the T1-weighted images (bottom row).
FIGURE 4.
Follow-up magnetic resonance images at the postoperative 20th day. The multiple abnormal signals on the diffusion-weighted images (top row), T2-weighted images (middle row), and fluid attenuated inversion recovery images (bottom row) mostly disappeared. There was no cystic degeneration resulting from the cerebral infarct.
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