Cerebral fat embolism
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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 presenationpresentation
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.
Radiographic features
CT brain
The CT brain can be normal in most cases 8. The may be evidence of diffuse edema with scattered low-attenuating areas and haemorrhage in some situations.
MRI brain
-
T2 - may show multiple
nonconfluentnon-confluent areas of high signal intensity, -
DWI - may show bright spots on a dark background (
“starfield”“starfield pattern) corresponding to the region of T2 signal abnormality. - T1 - corresponding focal regions may show low T1 signal 9
Differential diagnosis
For the "starfield pattern" on MRI, possible considerations include 6
- diffuse axonal injury
- cardiogenic or septic cerebral emboli
- cerebral vasculitis
- minute haemorrhagic cerebral metastases
-<p><strong>Cerebral fat embolism (CFE) </strong>is one of a manifestations of <a title="Fat embolism syndrome" 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 presenation</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 features aid in diagnosis.</p><h4>Radiographic features</h4><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 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>
-<strong>T2</strong> - may show multiple nonconfluent areas of high signal intensity,</li>- +<strong>T2</strong> - may show multiple non-confluent areas of high signal intensity</li>
-<strong>DWI</strong> - may show bright spots on a dark background (“starfield” pattern) corresponding to the region of T2 signal abnormality. </li>- +<strong>DWI</strong> - may show bright spots on a dark background (“<a title="starfield pattern" href="/articles/starfield-pattern">starfield pattern</a>) corresponding to the region of T2 signal abnormality. </li>
- +<li>
- +<strong>T1</strong> - corresponding focal regions may show low T1 signal <sup>9</sup>
- +</li>
- +</ul><h4>Differential diagnosis</h4><p>For the "starfield pattern" on MRI, possible considerations include <sup>6</sup></p><ul>
- +<li><a title="Diffuse axonal injury (DAI) grading" href="/articles/grading-of-diffuse-axonal-injury">diffuse axonal injury</a></li>
- +<li>cardiogenic or septic cerebral emboli</li>
- +<li>cerebral vasculitis</li>
- +<li>minute haemorrhagic cerebral metastases</li>
References changed:
- 1. Parizel PM, Demey HE, Veeckmans G et-al. Early diagnosis of cerebral fat embolism syndrome by diffusion-weighted MRI (starfield pattern). Stroke. 2001;32 (12): 2942-4. <a href="http://stroke.ahajournals.org/content/32/12/2942.full">Stroke (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/11740000">Pubmed citation</a><span class="auto"></span>
- 2. Goenka N, Ropper AH. Images in clinical medicine. Cerebral fat embolism. N. Engl. J. Med. 2012;367 (11): 1045. <a href="http://dx.doi.org/10.1056/NEJMicm1100944">doi:10.1056/NEJMicm1100944</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/22970947">Pubmed citation</a><span class="auto"></span>
- 3. Simon AD, Ulmer JL, Strottmann JM. Contrast-enhanced MR imaging of cerebral fat embolism: case report and review of the literature. AJNR Am J Neuroradiol. 2003;24 (1): 97-101. <a href="http://www.ajnr.org/content/24/1/97.full">AJNR Am J Neuroradiol (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12533333">Pubmed citation</a><span class="auto"></span>
- 4. Dhakal LP, Bourgeois K, Barrett KM, Freeman WD. The "starfield" pattern of cerebral fat embolism from bone marrow necrosis in sickle cell crisis. (2015) The Neurohospitalist. 5 (2): 74-6. <a href="https://doi.org/10.1177/1941874414554300">doi:10.1177/1941874414554300</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25829988">Pubmed</a> <span class="ref_v4"></span>
- 7. Chrysikopoulos H, Maniatis V, Pappas J et-al. Case report: post-traumatic cerebral fat embolism: CT and MR findings. Report of two cases and review of the literature. Clin Radiol. 1996;51 (10): 728-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8893645">Pubmed citation</a><span class="auto"></span>
- 6. Gibbs WN, Opatowsky MJ, Burton EC. AIRP best cases in radiologic-pathologic correlation: cerebral fat embolism syndrome in sickle cell β-thalassemia. Radiographics. 2012;32 (5): 1301-6. <a href="http://dx.doi.org/10.1148/rg.325115055">doi:10.1148/rg.325115055</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/22977019">Pubmed citation</a><span class="auto"></span>
- 5. Shaikh N, Parchani A, Bhat V et-al. Fat embolism syndrome: clinical and imaging considerations: case report and review of literature. Indian J Crit Care Med. 2008;12 (1): 32-6. <a href="http://dx.doi.org/10.4103/0972-5229.40948">doi:10.4103/0972-5229.40948</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760911">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19826589">Pubmed citation</a><span class="auto"></span>
- 8. Stoeger A, Daniaux M, Felber S et-al. MRI findings in cerebral fat embolism. Eur Radiol. 1999;8 (9): 1590-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9866767">Pubmed citation</a><span class="auto"></span>
- 9. Kawano Y, Ochi M, Hayashi K et-al. Magnetic resonance imaging of cerebral fat embolism. Neuroradiology. 1991;33 (1): 72-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2027452">Pubmed citation</a><span class="auto"></span>
- 10. Erdem E, Namer IJ, Saribas O et-al. Cerebral fat embolism studied with MRI and SPECT. Neuroradiology. 1993;35 (3): 199-201. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8459919">Pubmed citation</a><span class="auto"></span>
- 11. Takahashi M, Suzuki R, Osakabe Y et-al. Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations. J Trauma. 1999;46 (2): 324-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10029041">Pubmed citation</a><span class="auto"></span>
Systems changed:
- Central Nervous System
Images Changes:
Image 1 MRI (T2) ( create )
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