Abstract
Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier. Continued neuromonitoring revealed nonconvulsive status epilepticus. Magnetic resonance imaging of the brain showed multiple bilateral acute cerebral infarcts with a specific pattern favoring the diagnosis of fat embolism syndrome. He was found to have a significant right to left intracardiac shunt on a transesophageal echocardiogram. He improved substantially over time with supportive therapy, was successfully extubated on day 6, and discharged to inpatient rehabilitation on postoperative day 15. Fat embolisms can result in a wide range of neurologic manifestations. Nonrefractory nonconvulsive status epilepticus that responds to antiepileptic drugs, sedation, and supportive therapy can have a favorable outcome. A high index of suspicion and early recognition reduces the chances of unnecessary interventions and may improve survival.
Highlights
Fat embolism syndrome (FES) consists of respiratory manifestations, cerebral symptoms, and cutaneous petechiae as a result of fat emboli causing tissue damage through vascular occlusion, ischemia, and activation of coagulation and systemic inflammatory response [1, 2]
Nonconvulsive status epilepticus (NCSE) is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity lasting at least 30 minutes [6]
We report a case of a male with nonconvulsive status epilepticus as first manifestation of fat embolism syndrome in the setting of orthopedic fixation of an acute right femur fracture after a motor vehicle accident
Summary
Fat embolism syndrome (FES) consists of respiratory manifestations, cerebral symptoms, and cutaneous petechiae as a result of fat emboli causing tissue damage through vascular occlusion, ischemia, and activation of coagulation and systemic inflammatory response [1, 2]. It can occur following pelvic or long bone fractures as well as after orthopedic operations or any clinical condition where fat is manipulated. We report a case of a male with nonconvulsive status epilepticus as first manifestation of fat embolism syndrome in the setting of orthopedic fixation of an acute right femur fracture after a motor vehicle accident
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
