Cerebral fat embolism and the "starfield" pattern: a case report

Abstract

Nearly all long-bone fractures are accompanied by some form of fat embolism. The rare complication of clinically significant fat embolism syndrome, however, occurs in only 0.9-2.2% of cases. The clinical triad of fat embolism syndrome consists of respiratory distress, altered mental status, and petechial rash. Cerebral fat embolism causes the neurologic involvement seen in fat embolism syndrome. A 19-year-old African-American male was admitted with gunshot wounds to his right hand and right knee. He had diffuse hyperactive deep tendon reflexes, bilateral ankle clonus and decerebrate posturing with a Glasgow Coma Scale (GCS) score of 4T. Subsequent MRI of the brain showed innumerable punctate areas of restricted diffusion consistent with "starfield" pattern. On a 10-week follow up he has a normal neurological examination and he is discharged home. Despite the severity of the neurologic insult upon initial presentation, the majority of case reports on cerebral fat embolism illustrate that cerebral dysfunction associated with cerebral fat embolism is reversible. When neurologic deterioration occurs in the non-head trauma patient, then a systemic cause such as fat emboli should be considered. We describe a patient with non-head trauma who demonstrated the classic "starfield" pattern on diffusion-weighted MRI imaging.

Computed tomographic findings of cerebral fat embolism following multiple bone fractures

“…Most patients with CFE show complete neurological recovery despite initial cerebral dysfunction and prolonged coma. (6,8,14) This is also true in our patient, who was discharged from the hospital one month later without any neurological sequelae.…”

AIRP Best Cases in Radiologic-Pathologic Correlation: Cerebral Fat Embolism Syndrome in Sickle Cell β-Thalassemia

“…Characteristic findings on diffusion-weighted and susceptibility-weighted MR images provide valuable supporting evidence for the diagnosis of cerebral fat embolism syndrome. The starfield pattern, which consists of innumerable bright punc-tate foci of restricted diffusion against the dark background of brain parenchyma, has a limited differential diagnosis including diffuse axonal injury; cardiogenic, septic, or fat emboli; vasculitis; and minute hemorrhagic metastases (11)(12)(13)(14). In cerebral fat embolism syndrome, this pattern is thought to represent numerous sites of cytotoxic edema related to hemorrhage and infarction due to cerebral vessel occlusion by fat emboli.…”

“…In a number of reported cases, patients with cerebral fat embolism due to trauma experienced neurologic changes that were transient and eventually followed by a full recovery (11)(12)(13)15). In patients with sickle cell disease, the clinical course of fat embolism is more often fulminant.…”

Fat Embolism Syndrome with Cerebral Involvement in a Multitrauma Patient

“…Many researchers have reported that diffusion weighted cranial MRI is a useful adjunct in recognizing cerebral FES. [9][10][11] In our patient, cranial MRI was consistent with cerebral involvement. He had many scattered small lesions of limited diffusion within both cerebral hemispheres, basal ganglia, centrum semiovale and corpus callosum (Figure 1).…”