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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May 6, 2013
Cerebral Fat Embolism (with Associated Shear Injury)
- Cerebral fat emboli are thought to be associated with 0.5-3.5% of displaced long bone fractures and can be a serious, potentially life-threatening complication.
- Patients with cerebral fat emboli present with a spectrum of neurological findings ranging from altered consciousness to coma/seizures. Usually the clinical course is self-limiting, with gradual recovery of neurological function in days to months. Some cases may be fatal.
- Key Diagnostic Features: Multiple diffuse, punctate foci of hyperintense T2/FLAIR signal with restricted diffusion and signal dropout on susceptibility weighted imaging (SWI). SWI is more sensitive than conventional GRE, given the suspected punctate hemorrhages resulting from the vascular injury as well as SWI’s high sensitivity to blood products and changes in iron content.
- DDx: Diffuse axonal injury
- Rx: This is a self-limiting condition that usually resolves within days to months.
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