cerebral fat embolism

Cerebral fat
embolism (ECR 2016 Case of the Day). Head MRI showed numerous punctate T2 and FLAIR hyperintensities in subcortical and deep white matter.
www.eurorad.org • CC by-nc-sa-4.0
Microbleeds
show a characteristic distribution in cerebral fat embolism. A case representing the starfield pattern of restricted diffusion. MRI scan of an 18-year-old man with a closed displaced fracture of the left femoral shaft after a high velocity motor vehicle accident. Diffusion-weighted MR Image (10000/89; b value, 1000 s/mm2) showing foci of hyperintensities within both centrum ovale (a), and the corresponding ADC map confirming restricted diffusion (b). Published under the permission of G. Bierry and S. Kremer, Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
insightsimaging.springeropen.com • CC-by-4.0
Cerebral fat
embolism after traumatic bone fractures: a structured literature review and analysis of published case reports. Axial FLAIR (a) magnetic resonance imaging sequence shows the presence of numerous multifocal hyperintensities involving the deep white matter of both hemispheres (arrow), which correspond to innumerable tiny foci of diffusion restrictions on DWI (b) with low signal on ADC map (c) (arrow). These findings are the so-called “starfield” pattern characteristic of cerebral fat embolism syndrome. In the same patient, the SE-T1W (d) and T2* GRE (f) sequences, and the axial non enhanced computed tomography NECT scan (f) appear relatively normal
sjtrem.biomedcentral.com • CC-by-4.0
Cerebral fat
embolism (ECR 2016 Case of the Day). Subcortical and deep white matter lesions with hyperintense signal on diffusion-weighted imaging were hypointense on corresponding apparent diffusion coefficient maps, suggesting restriction of water diffusion.
www.eurorad.org • CC by-nc-sa-4.0
Cerebral fat
embolism (ECR 2016 Case of the Day). Multiple hypointense foci were scattered throughout the cerebral white matter on susceptibility weighted imaging, representing microbleeds.
www.eurorad.org • CC by-nc-sa-4.0
Cerebral fat
embolism (ECR 2016 Case of the Day). Multiple hypointense foci were scattered throughout the cerebral white matter on susceptibility weighted imaging representing microbleeds.
www.eurorad.org • CC by-nc-sa-4.0
Microbleeds
show a characteristic distribution in cerebral fat embolism. A case showing microhemorrhages as seen on CT. Axial native CT scan images at the level of the centrum semiovale and the basal ganglia of a 16-year-old polytraumatised female patient acquired on postoperative day 11 after hospital admission. Multiple subcortical punctiform hyperdensities presumably representing microhemorrhages are seen bilaterally in the subcortical white matter (a), and a larger hyperdensity is seen in the genu of the corpus callosum (b)
insightsimaging.springeropen.com • CC-by-4.0
Microbleeds
show a characteristic distribution in cerebral fat embolism. A case representing the various patterns of diffusion abnormalities seen in CFE. T2 (a, b), DWI (c, d), and ADC (e, f) MRI images at the level of the centrum semiovale (left column), and at the level of the basal ganglia (right column) of a 16-year-old polytraumatised female patient acquired on day 12 after hospital admission. T2 weighted images show hyperintense signal in the subcortical white mater, internal capsule and the corpus callosum (a, b). Diffusion-weighted MR Image with a b value of 1000 s/mm2 (c, d), and ADC (e, f) images show cytotoxic edema affecting the corpus callosum and facilitated diffusion over the subcortical white matter
insightsimaging.springeropen.com • CC-by-4.0
Microbleeds
show a characteristic distribution in cerebral fat embolism. A case representing the walnut kernel microbleed pattern. SWI (a–d) MRI images at the level of the centrum semiovale (a), at the level of the corona radiata (b), at the level of the basal ganglia (c), and at the level of the brainstem and the cerebellum (d) of a 16-year-old polytraumatised female patient acquired on day 12 after hospital admission. SWI shows very high number of monotonous punctuate microbleeds in the subcortical white matter, the internal capsule, the corpus callosum, the cerebellum and the brainstem resembling a “walnut kernel”. The larger hypointensity visible in the right centrum semiovale and near the third ventricle is due to a ventricular drain (a–c)
insightsimaging.springeropen.com • CC-by-4.0
Microbleeds
show a characteristic distribution in cerebral fat embolism. A case representing the long-term radiological consequences of CFE. T2 MRI images at the level of the basal ganglia of a 16-year-old polytraumatised female patient acquired on day 12 after hospital admission (a), and 16 months later (b). The long-term follow-up images show resolution of the subcortical and corpus callosum T2 hyperintensities, and dilation of the intergyral sulci, and the lateral ventricles indicative of cerebral atrophy (b)
insightsimaging.springeropen.com • CC-by-4.0
Cerebral fat
embolism (ECR 2016 Case of the Day). Most of the lesions in subcortical and deep white matter of the cerebrum as well as in the basal ganglia and in the cerebellum were hyperintense on diffusion-weighted imaging.
www.eurorad.org • CC by-nc-sa-4.0
Starfield
pattern (fat embolism) • Cerebral fat embolism syndrome - Ganzer Fall bei Radiopaedia
Dixon, A. Cerebral fat embolism syndrome. Case study, Radiopaedia.org. (accessed on 02 Nov 2022) https://doi.org/10.53347/rID-39034 • CC by-nc-sa 3.0 (modified)
Cerebral fat
embolism • Cerebral fat embolism (type 2A) - confluent edema in white matter - Ganzer Fall bei Radiopaedia
Hanh L, Cerebral fat embolism (type 2A) - confluent edema in white matter. Case study, Radiopaedia.org (Accessed on 08 Dec 2022) https://doi.org/10.53347/rID-90839 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Cerebral fat embolism is one manifestation of fat embolism syndrome.

Epidemiology

Cerebral fat embolism typically occurs in patients with bony fractures (usually long bones of the lower limb). Rarely it has been described as part of a sickle cell crisis with bone marrow fat necrosis and subsequent embolism .

Clinical presentation

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.

Pathology

Fat emboli usually reach the brain through either right-to-left cardiac shunt or through an intact pulmonary circulation in those without a shunt .

Radiographic features

CT 

The CT brain can be normal in most cases . There may be evidence of diffuse edema with scattered low-attenuating areas and hemorrhage in some situations.

MRI 
  • 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
  • T1: corresponding focal regions may show low T1 signal

Differential diagnosis

A differential to consider for the starfield pattern on MRI includes many other causes of multiple small foci of infarction or hemorrhage, although generally, only fat emboli will result in the very large number of tiny lesions characteristic of a starfield appearance. Other diagnoses to consider :

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu zerebrale Fettembolie:
Diffuses
axonales Schädelhirntrauma
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Fettembolie
 
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Fett in den
Hirnventrikeln
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zerebrale
Luftembolie
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eingeblutete
zerebrale Metastasen
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