Cerebral Fat Embolism Studied by Magnetic Resonance Imaging, Transcranial Doppler Sonography, and Single Photon Emission Computed Tomography

Abstract

Cerebral fat embolism syndrome is an uncommon complication of trauma. We present a patient who developed cerebral fat embolism syndrome secondary to long-bone fractures. Although computed tomography of the brain failed to show any intracranial lesion, magnetic resonance imaging (MRI) detected scattered, high-signal-intensity lesions on T2-weighted images. 99mTc-d, 1-hexamethyl-propylene amine oxine single photon emission computed tomography (99mTc-HMPAO SPECT) and transcranial Doppler sonography (TCD) demonstrated low cerebral blood flow in the acute stage. MRI, 99mTc-HMPAO SPECT, and TCD correlated well with the clinical course of cerebral fat embolism syndrome.

Fat embolism

“…Magnetic resonance imaging (MRI) shows greater promise as it may detect lesions in the presence of a normal CT scan. Specific changes include both lowdensity areas on T1-weighted images and high-density regions on T2-weighted images [26]. The distribution of involvement seen on MRI may be characteristic (cerebral deep white matter, basal ganglia, corpus callosum and cerebellar hemispheres).…”

Clinical and Radiographic Improvement Following Cerebral Fat Emboli

“…Clinical diagnosis of cerebral fat embolism may be aided by Gurd's diagnostic criteria [11], and should be suspected in trauma patients with long-bone fractures and otherwise unexplained neurological deterioration [12,13]. Imaging with head CT typically does not reveal abnormalities [14][15][16][17]. In contrast, MRI often demonstrates an early pattern of multiple punctuate areas of increased T2 signal, which have been described as a ''starfield pattern'' [16].…”

Posttraumatic Paradoxical Fat Embolism to the Brain: A Case Report

“…Not surprisingly, the recordings with the highest magnitude were seen in a patient with a patent foramen ovale. 8,13 Radiologic investigations many times fail to identify the injury caused by fat emboli in the lung or the brain. Fat emboli causing hypoxemia will prompt the clinician to obtain a chest radiograph, which will often show nonspecific infiltrates.…”

“…14 Magnetic resonance imaging is a very sensitive tool used to detect embolic infarcts that are seen as scattered high-intensity signals on T2-weighted images. 8 Even earlier diagnosis of cerebral embolic events can be obtained with diffusion-weighted MRI methods that yield low-resolution images at the cost of decreased specificity. MRI technology is further limited by its inability to identify the nature of emboli, and other studies are often required to evaluate embolic sources.…”