Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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March 5, 2012
Acute Cerebral Fat Embolism
- Usually occurs with long-bone fractures; an sometimes be seen in small-bone fractures and after orthopedic manipulation or intervention.
- Clinical presentation: triad of hypoxia, cutaneous petechial hemorrhage, and variable neurologic dysfunction
- Key Diagnostic Features: MRI studies demonstrate multiple small, nonconfluent lesions appearing hypointense on T1WI, and hyperintense on FLAIR and T2 WI. These lesions appear bright on diffusion-weighted imaging and correspond to foci of restricted diffusion on ADC maps. They are thought to represent microinfarcts arising from fat emboli occluding cerebral arterioles. Occasionally, these lesions do not demonstrate restricted diffusion, suggesting the possibility of associated vasogenic edema. Contrast-enhancement can occur and results from breakdown of blood-brain barrier.
- Laboratory evaluation: reduced hematocrit, thrombocytopenia, high serum lipase level, cytologic examination of urine, blood, and sputum demonstrates fat globules.
- DDx: Diffuse axonal injury
- Rx: Mechanical ventilation, fracture reduction, intravascular volume maintenance
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