Compare a recent case of CFE to prior cases at our level II trauma center.

CFE is a rare complication of long bone fractures and can be difficult to differentiate from diffuse axonal injury (DAI). However, the historical prognosis of CFE is excellent.

An index case (IC) of CFE initially diagnosed as DAI prompted review of our trauma database of 9811 patients from October 1, 2015 to October 20, 2018 for cases of cerebral fat embolus.

In addition to the IC (female, age 63, initial GCS 13) we found two additional CFE patients (male, age 24, initial GCS 15; female, age 20, initial GCS 9). All patients were in motor vehicle crashes, had bilateral femur fractures, and fixation procedures. In addition, the IC had an open laparotomy for extensive bowel injury. After orthopedic fixations, the IC and male patient had nonfocal neurological decline to GCS 4 and 6 respectively. All brain MRI showed multifocal small areas of restricted diffusion. No patients had skin rash. The male patient had near resolution of restricted diffusion MRI changes in seven days. The younger patients were discharged to rehabilitation with GCS 15, the IC was discharged to inpatient hospice at day 10 with GCS 7.

CFE is a rare condition associated with long bone fractures. Intramedullary fixation procedures may be a risk factor. The diffuse abnormalities on brain MRI can be mistaken for DAI, but the prognosis of CFE is generally better than DAI. Rapid resolution of the MRI abnormalities can be seen. Decisions to limit care in post-traumatic CFE should be based on the totality of the injury along with a thorough discussion of goals of care, not the neurologic presentation alone.