Cerebral Fat Embolism Syndrome With Large-Vessel Occlusion Following Sequential Bilateral Femoral Neck Fractures: A Case Report

Cerebral fat embolism syndrome (CFES) is a subset of fat embolism syndrome (FES) in which neurological manifestations predominate, making diagnosis using standard clinical criteria challenging.Large-vessel occlusion (LVO) associated with CFES is rare, with poor outcomes reported in the limited available literature.We present the case of a 74-year-old woman who sustained sequential bilateral femoral neck fractures following two separate mechanical falls.Both fractures were treated with hemiarthroplasties approximately 48 hours apart.Following the second operation, she failed to regain consciousness after general anaesthesia.CT angiography demonstrated occlusion in the right internal carotid artery (ICA) terminus extending into the M2 segment of the middle cerebral artery (MCA) with an additional distal M3 embolus.Subsequent MRI demonstrated a multi-territory starfield pattern alongside an established right MCA territorial infarct.Mechanical embolectomy was considered but not pursued because of the anticipated substantial postprocedural morbidity.Despite maximal supportive care, her neurological status remained unchanged.Given her poor overall prognosis, she was transitioned to comfort care and passed away.This case report highlights the diagnostic challenge of CFES without prominent respiratory or cutaneous manifestations, the value of early neuroimaging, and the emerging role of embolectomy in the LVO subtype.The closely spaced fractures and procedures raise the possibility of cumulative embolic exposure, although a causal relationship cannot be established from this case.