Cerebral fat embolism syndrome and the use of multimodal neuromonitoring and corticosteroid treatment

Cerebral fat embolism syndrome is a rare complication of long-bone fractures. We describe a case of severe cerebral fat embolism after orthopaedic trauma sustained in a road traffic collision. The case is notable for the severity of neurological involvement, the application of multimodal neuromonitoring to guide care and the use of methylprednisolone as part of management. The patient was admitted to the neurointensive care unit and managed with standard neuroprotective measures. Imaging on day 10 demonstrated worsening cerebral oedema with transtentorial herniation. Intracranial pressure (ICP) and brain tissue oxygenation monitoring were initiated, and methylprednisolone was administered. Over the subsequent days the ICP stabilised and the cerebral oedema improved. This case illustrates the potential severity of cerebral fat embolism and adds to the limited literature on the use of methylprednisolone in its management. It also highlights a role of multimodal neuromonitoring in guiding management and informing clinical decision-making in such patients.