Atypical cerebral fat embolism syndrome in an elderly patient with comorbidities following fracture: A case report

RATIONALE: Cerebral fat embolism (CFE) is a rare but serious complication of fractures, most commonly affecting young males. However, atypical cases in elderly patients with underlying comorbidities are easily misdiagnosed. PATIENT CONCERNS: We report a case of a 61-year-old male patient with diabetes and hypertension who developed impaired consciousness and fever on the 2nd day after sustaining multiple fractures in a traffic accident. His condition deteriorated after receiving local treatment. DIAGNOSES: CFE was diagnosed based on the characteristic "starry sky sign" on brain magnetic resonance imaging-diffusion-weighted imaging after excluding other common causes of stroke. INTERVENTIONS: The patient received comprehensive supportive care, including anticoagulation, hyperbaric oxygen therapy, and early surgical fracture fixation. OUTCOMES: The patient's level of consciousness improved. Following stabilization, rehabilitation therapy was initiated. LESSONS: For atypical CFE patients lacking respiratory symptoms and skin hemorrhagic spots, early diagnosis is challenging and prone to being missed. Only through early detection and prompt, aggressive treatment can prognosis be improved.