Fat embolism syndrome (FES) is a collection of signs and symptoms typically occurring 12 to 36 hours after trauma or surgery and consisting of the classical triad of respiratory insufficiency, skin petechiae, and cerebral decompensation.1,2 It is often the sequelae of displaced long bone fractures of the lower extremities, and is a potentially lethal complication. 3Neurologic involvement in FES has been termed cerebral fat embolism (CFE) and has traditionally presented a diagnostic challenge. Computed tomography (CT) has demonstrated only limited sensitivity in the diagnosis of CFE. 4,5 Traditional T1, T2, and proton density magnetic resonance imaging (MRI) sequences have proven effective in the diagnosis of CFE. [6][7][8][9] Relatively new diffusion weighted imaging (DWI) techniques used in the setting of acute cerebral stroke are more sensitive than T2 weighted imaging.10 Diffusion weighted imaging may offer improved diagnostic potential in the setting of CFE. The application of DWI in two cases of CFE is discussed. PATIENT 1A 25-year-old male presented to a major trauma center following a motorcycle accident. The patient had sustained a closed, transverse, proximal left femur fracture. There was momentary loss of consciousness at the scene with a normal admission head CT scan. The injury was treated by open reduction with intramedullary rod and screw fixation on the same day. ABSTRACT:The use of diffusion weighted imaging with apparent diffusion coefficient mapping in the diagnosis of cerebral fat embolism is shown here to demonstrate infarcts secondary to fat emboli more intensely than T2 weighted sequences 24 hours after the onset of symptoms. Embolic foci are hypointense on apparent diffusion coefficient mapping consistent with cytotoxic edema associated with cell death and restricted water diffusion. This technique increases the sensitivity for detecting cerebral fat embolism and offers a potentially important tool in its diagnosis. RÉSUMÉ: Imagerie de diffusion parrésonance magnétique dans l'embolie graisseuse cérébrale. L'utilisation de l'imagerie de diffusion par résonance magnétique avec cartographie du coefficient apparent de diffusion pour diagnostiquer l'infarctus secondaire à l'embolie graisseuse visualise mieux ces infarctus que les séquences pondérées T2, 24 heures après le début des symptômes. Les foyers emboliques sont hypointenses à la cartographie par mesure du coefficient apparent de diffusion, ce qui est compatible avec un oedème cytotoxique associé à la mort cellulaire et une diffusion aqueuse réduite. Cette technique est plus sensible pour détecter l'embolie graisseuse cérébrale et pourrait s'avérer un outil précieux pour poser ce diagnostic.
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