CEREBRAL FAT-EMBOLISM FOLLOWING CLOSED LE G TRAUMA

A 21-year-old man sustained a closed fracture of the leg from an indus trial accident, without associated head trauma. The orthopaedic treatm ent consisted of immediate immobilization by setting leg in plaster. T wo hours after admission, the Glasgow coma scale score was 10. Four ho urs after admission he developed a coma (Glasgow coma scale score = 7) with repetitive seizures. No lesion was visible on cerebral CT scan. Chest X-ray was unremarquable. Petechiae on the anterior chest wall an d abdomen with bilateral mydriasis occurred. Thrombocytopenia with pro thrombine time increase were observed. Magnetic resonance imaging, 27 hours after admission, showed high-intensity areas on T2 weighted view s due to fat embolism. Retinal haemorrhages were observed. The broncho alveolar lavage showing fat staining of tracheal aspirates confirmed t he diagnosis of fat embolism. This case report emphasizes the possibil ity of predominant neurologic manifestations of a fat embolism and the diagnostic help of cerebral magnetic resonance imaging.