CASE REPORT   

Journal of Radiological Review 2020 March-April;7(2):137-43

DOI: 10.23736/S2723-9284.20.00255-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English, Italian

Endoliquoral cerebral fat embolism: a rare post-traumatic case

Maurizio COMORETTO ¹ ✉, Michela ZUZZI ², Massimo MASCOLO ³

¹ Department of Radiology, San Giorgio Hospital, Pordenone, Italy; ² Department of Orthopedics, San Giorgio Hospital, Pordenone, Italy; ³ Departmernt of Neurology, San Giorgio Hospital, Pordenone, Italy

Following traumatic events, the release of fat and bone marrow fragments in the blood bed is a common eventuality. In most cases, this condition is asymptomatic or causes only minor disorders, but sometimes it can lead to multi-organ dysfunction, whose severity ranges from mild to fatal. Cerebral fat embolism (CFE) is an unusual form of fat embolism syndrome (FES), characterized by purely cerebral involvement, in the absence of pulmonary and cutaneous co-involvement. It usually occurs 12 to 72 hours after the triggering event, mainly represented by multiple closed fractures to the long bones of the lower limbs. Neurological manifestations are mainly characterized by headache, confusion, convulsions, focal deficit and alteration of the state of consciousness, up to coma. Clinical diagnosis represents a challenge, since the neurological signs and symptoms are highly variable and most of the time nonspecific. Neuroimaging, mainly magnetic resonance imaging (MRI) therefore becomes an indispensable diagnostic aid, allowing you to reach an early and safe diagnosis. In particular, diffusion-weighted MRI (DW-MRI) can highlight a typical “star field” pattern, linked to the presence of cerebral microinfarctions with cytotoxic necrosis phenomena. In this work we report a case of cerebral endoliquoral adipose embolism, which occurred after a traumatic event with a consequent acetabular fracture. To our knowledge this is the first reported in literature, which we related to the cases of cerebral adipose embolism. In the case we exhibited, computed tomography performed under an emergency and under basal conditions was sufficient to support the diagnosis of liquoral fat embolism. The picture was subsequently confirmed by magnetic resonance imaging.

KEY WORDS: Brain; Embolism, fat; Magnetic resonance imaging; Tomography, X-ray computed