- Generally caused by the venous embolization of fat from long bone fractures, orthopedic surgery, venous-arterial shunts or cardiac surgery sending emboli into the systemic circulation embolizing the brain or kidneys most commonly.
- Fat lobules are transferred from the venous system to the arterial system either through direct shunting or by passing directly through pulmonary capillaries.
- When fat emboli enter the brain neurological symptoms are nonspecific and highly variable ranging from headache and confusion to coma or seizures.
- Fat Embolism Syndrome manifests as the triad of pulmonary, central nervous and cutaneous symptoms (e.g. Hypoxia, Altered mental status and petechial rash.)
- Radiographic findings are most specific using MR diffusion weighted imaging.
- Multiple scattered foci of diffusion restriction within the gray and/or white (star field pattern) consistent with diffuse acute infarctions is the earliest and most specific finding. The quantity of focal diffusion abnormalities correlates with GCS score.
- T2 findings may present later with multiple scattered foci of increased signal intensity.
- Non-enhanced CT can demonstrate the “hyPOdense MCA sign” due to fat within the MCA.
- There is a wide range of commonly affected territories: deep and periventricular white matter, deep gray nuclei, typical vascular territory as well as "watershed" territories.
- Parizel PM et al: Early diagnosis of cerebral fat embolism syndrome by diffusion-weighted MRI (starfield pattern). Stroke. 32(12):2942-4, 2001
- Karen L. Salzman, MD. Cerebral Infarction, Fat Emboli. Retrieved from https://app.statdx.com/document/cerebral-infarction-fat-emboli/1e545393-1f5a-4246-bed2-5f9197e4b258
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