Cerebral fat embolism
Updates to Article Attributes
Cerebral fat embolism (CFE) is one of a manifestations of fat embolism syndrome.
Epidemiology
It typically occurs in patients with bony fractures (usually long bones of the lower limb).
Pathology
Fat emboli usually reach the brain through a either right-to-left cardiac shunt or through an intact pulmonary circulation in those without a shunt 4.
Clinical presentation
Cerebral manifestations of fat embolism syndrome can be highly variable and nonspecificnon-specific: the symptoms spectrum includes headache, lethargy, irritability, delirium, stupor, convulsions, or coma. Most cases can occur as subclinical events. Concurrent pulmonary or cutaneous features may aid in diagnosis.
Radiographic features
CT brain
The CT brain can be normal in most cases 8. The may be evidence of diffuse edemaoedema with scattered low-attenuating areas and haemorrhage in some situations.
MRI brain
- T2: may show multiple non-confluent areas of high signal intensity
- DWI: may show bright spots on a dark background (“starfield pattern) corresponding to the region of T2 signal abnormality.
- SWI: may distinctly demonstrate multiple minute hypointense foci in the brain 12-13
- T1: corresponding focal regions may show low T1 signal 9
Differential diagnosis
For the "starfield pattern" on MRI, possible differential considerations include 6
- diffuse axonal injury
- cardiogenic cerebral emboli or septic cerebral emboli
- cerebral vasculitis
- minute haemorrhagic cerebral metastases
-<p><strong>Cerebral fat embolism (CFE) </strong>is one of a manifestations of <a href="/articles/fat-embolism-syndrome">fat embolism syndrome</a>.</p><h4>Epidemiology</h4><p>It typically occurs in patients with bony fractures (usually long bones of the lower limb).</p><h4>Pathology</h4><p>Fat emboli usually reach the brain through a either right-to-left cardiac shunt or through an intact pulmonary circulation in those without a shunt <sup>4</sup>.</p><h4>Clinical presentation</h4><p>Cerebral manifestations of fat embolism syndrome can be highly variable and nonspecific: the symptoms spectrum includes headache, lethargy, irritability, delirium, stupor, convulsions, or coma. Most cases can occur as subclinical events. Concurrent pulmonary or cutaneous features may aid in diagnosis.</p><h4>Radiographic features</h4><h5>CT brain</h5><p>The CT brain can be normal in most cases <sup>8</sup>. The may be evidence of diffuse edema with scattered low-attenuating areas and haemorrhage in some situations.</p><h5>MRI brain</h5><ul>- +<p><strong>Cerebral fat embolism (CFE) </strong>is one of a manifestations of <a href="/articles/fat-embolism-syndrome">fat embolism syndrome</a>.</p><h4>Epidemiology</h4><p>It typically occurs in patients with bony fractures (usually long bones of the lower limb).</p><h4>Pathology</h4><p>Fat emboli usually reach the brain through a either right-to-left cardiac shunt or through an intact pulmonary circulation in those without a shunt <sup>4</sup>.</p><h4>Clinical presentation</h4><p>Cerebral manifestations of fat embolism syndrome can be highly variable and non-specific: the symptoms spectrum includes headache, lethargy, irritability, delirium, stupor, convulsions, or coma. Most cases can occur as subclinical events. Concurrent pulmonary or cutaneous features may aid in diagnosis.</p><h4>Radiographic features</h4><h5>CT brain</h5><p>The CT brain can be normal in most cases <sup>8</sup>. The may be evidence of diffuse oedema with scattered low-attenuating areas and haemorrhage in some situations.</p><h5>MRI brain</h5><ul>
-</ul><h4>Differential diagnosis</h4><p>For the "starfield pattern" on MRI, possible considerations include <sup>6</sup></p><ul>- +</ul><h4>Differential diagnosis</h4><p>For the "starfield pattern" on MRI, possible differential considerations include <sup>6</sup></p><ul>
-<li>cardiogenic or septic cerebral emboli</li>-<li>cerebral vasculitis</li>-<li>minute haemorrhagic cerebral metastases</li>- +<li>cardiogenic cerebral emboli or septic cerebral emboli</li>
- +<li><a href="/articles/central-nervous-system-vasculitides">cerebral vasculitis</a></li>
- +<li>minute <a href="/articles/haemorrhagic-cerebral-metastases">haemorrhagic cerebral metastases</a>
- +</li>
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