Figure.4: MRI Brain shows extensive bilateral, symmetrical punctuate foci of nearly the same size and abnormal signal intensities giving the appearance of a starfield pattern on T2-weighted images with restricted diffusion.
On the fourth day of admission, bilateral palpebral conjunctival petechial spots also appeared. His pupils were isochoric, and the light reflex was bilaterally positive. There were no meningeal signs. The reflexes and cranial nerves were normal. He could move all 4 limbs. The Glasgow Coma Scale score was 12: E4V2M6. Cardiac echocardiography also revealed no evidence of patent foramen ovale.
Treatment:
One dose of hydrocortisone intravenously on day 1 of admission and subcutaneous heparin was given in view of the pulmonary embolism. His sensorium improved (GCS 15) with supportive measures. Respiratory distress was managed conservatively with oxygen by mask. The patient eventually improved with the same line of management.
Follow-up:
The patient was discharged with a repeat chest X-ray, which was normal, and hypoxia was quick to resolve with a repeat arterial blood gas (ABG) analysis showing normal parameters with follow-up at a multidisciplinary clinic and rehabilitation program.
Discussions:
Fat embolism syndrome (FES) is most frequently associated with trauma and orthopedic procedures and is characterized by major and minor findings, as defined by Gurd [5]. Three major criteria and two minor criteria marked by (*) in the [Table 1], was manifested in our patient making this a strong case of FES [5,6].