To date, there have been no reports of paroxysmal sympathetic hyperactivity syndrome (PSHS) associated with cerebral fat embolization. We describe the case of a young male who developed acute brain injury and acute hypoxemic respiratory failure secondary to significant fat embolization following a traumatic femur injury. Our patient demonstrated episodes of significant hypertension, tachycardia, fever and extensor posturing. Extensive evaluation lead to the diagnosis and appropriate treatment for PSHS. Ultimately, the patient went on to have a good neurologic recovery after a prolonged hospitalization. We will discuss PSHS diagnostic criteria, pathophysiology and treatment options. This diagnosis should be considered in all brain-injured patients with paroxysms of autonomic instability and abnormal movements.
Key words: acute brain injury, myoclonic encephalopathy, fat embolism, autonomic nervous system diseases, adult respiratory distress syndrome,wound, injuries