Cerebral fat embolism: An unusual case report and literature review

Abstract

Background: Fat embolism syndrome (FES) is a rare syndrome induced by embolization of lipid droplets in the bloodstream, commonly seen after long-bone fractures or orthopedic surgery. Case presentation: We report an unusual case of cognitive impairment following a motor scooter accident for which repeated brain MRI, performed on the tenth day after trauma, showed decreased hyperintense lesions on T2-FLAIR and DWI and numerous scattered small foci of low signal in the regions in T2*-weighted (T2*WI) gradient-echo and SWI images. Conclusion: We report a case of mental deterioration after a lucid interval that illustrates the usefulness of repeating brain MRI, especially the SWI sequence, to show the classic “starfield pattern” but also a possible dynamic and extensive appearance of hypointense punctate foci suggestive of the diagnosis. We recommend actively searching for an uncommon distal bone fracture if the initial body CT scan is negative and the diagnosis of CFE is suspected.

Keywords

• Cerebral fat embolism
• Microhemorrhage
• Susceptibility-weighted imaging