Transient cortical blindness due to cerebral fat embolism

Abstract

Fat embolism syndrome (FES) is a rare disorder most commonly manifested with respiratory insufficiency following long bone fractures or orthopedic surgery. The reported risk of FES following orthopedic trauma ranges between 1 to 30%.[1] The classical triad of FES includes respiratory insufficiency, neurological impairment, and petechial skin rash.[2] It usually occurs 24 to 72 h following the initial insult.[1] The clinical entity in which neurological signs and symptoms predominate is defined as cerebral FES (CFES). Neurological complications of CFES include ischemic or hemorrhagic strokes with focal neurological deficits, headache, apraxia, vision loss, seizures, convulsive and non-convulsive status epilepticus, autonomic dysfunction, acute encephalopathy, confusion, and coma.[3,4] Given the wide range of clinical signs and symptoms, the diagnosis depends on excluding other causes in high-risk patients with a history of trauma and surgery. Fat embolism syndrome (FES) is a disease that manifests with respiratory distress, neurological impairment, and petechial rash and develops due to embolization of fat particles into several organs after long bone fractures or orthopedic surgery. A 26-year-old male patient developed sudden vision loss 24 h after the tibial fracture. Except for visual acuity, other neurological and ophthalmological examinations were normal. He had transient cortical blindness due to central fat embolism secondary to dislocated tibia fracture. Although the major diagnostic criteria of FES include at least two skin, pulmonary and neurological involvements, cerebral fat embolism may occur alone without any additional organ involvement. Multiple brain fat embolism may lead to cortical blindness, which is usually transient.