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 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 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 considerations include 6
- diffuse axonal injury
- cardiogenic or septic cerebral emboli
- cerebral vasculitis
- minute haemorrhagic cerebral metastases
-<strong>T2</strong> - may show multiple non-confluent 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 (“<a href="/articles/starfield-pattern">starfield pattern</a>) corresponding to the region of T2 signal abnormality. </li>- +<strong>DWI:</strong> may show bright spots on a dark background (“<a href="/articles/starfield-pattern">starfield pattern</a>) corresponding to the region of T2 signal abnormality. </li>
-<strong>T1</strong> - corresponding focal regions may show low T1 signal <sup>9</sup>- +<strong>SWI: </strong>may distinctly demonstrate multiple minute hypointense foci in the brain <sup>12-13</sup>
- +</li>
- +<li>
- +<strong>T1:</strong> corresponding focal regions may show low T1 signal <sup>9</sup>
References changed:
- 13. Suh SI, Seol HY, Seo WK et-al. Cerebral fat embolism: susceptibility-weighted magnetic resonance imaging. Arch. Neurol. 2009;66 (9): 1170. <a href="http://dx.doi.org/10.1001/archneurol.2009.173">doi:10.1001/archneurol.2009.173</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/19752311">Pubmed citation</a><span class="auto"></span>
- 12. Zaitsu Y, Terae S, Kudo K et-al. Susceptibility-weighted imaging of cerebral fat embolism. J Comput Assist Tomogr. 2010;34 (1): 107-12. <a href="http://dx.doi.org/10.1097/RCT.0b013e3181a962c1">doi:10.1097/RCT.0b013e3181a962c1</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/20118732">Pubmed citation</a><span class="auto"></span>
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