Fat embolism syndrome is a potentially catastrophic complication of long-bone fractures. The classic triad of symptoms are petechial skin rashes, hypoxemia, and neurological abnormalities, which usually occur within 24 to 72 hours after the fracture. The respiratory component occurs in practically all of the reports. We present the case of a patient with post traumatic fat embolism with predominant neurological symptoms, without respiratory involvement in the absence of patent foramen ovale.