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NEUROIMAGE
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Cerebral Fat Embolism: A Rare Cause of Juvenile Stroke


 Institute of Neurology, Catholic University of the Sacred Heart, and Institute of Neurology, Department of Aging, Neuroscience, Orthopedics, Head and Neck Sciences, “A. Gemelli” University Polyclinic Foundation IRCCS, Rome, Italy

Correspondence Address:
Tommaso Nicoletti,
Institute of Neurology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, Roma - 00168
Italy
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.294540




How to cite this URL:
Nicoletti T, Genovese D, Di Iorio R, Marca GD. Cerebral Fat Embolism: A Rare Cause of Juvenile Stroke. Neurol India [Epub ahead of print] [cited 2020 Sep 18]. Available from: http://www.neurologyindia.com/preprintarticle.asp?id=294540




A 16-year-old boy presented with encephalopathy and respiratory distress three days after a long-bone fracture repair. Head computed tomography (CT) was unremarkable. Chest CT depicted pulmonary lesions with ground-glass opacities and “crazy-paving” pattern [Figure 1]c. Brain magnetic resonance imaging (MRI) showed spotty diffusion-restricted and T2-hyperintense foci involving basal ganglia, subcortical white matter, splenium and centrum semiovale, without (micro) hemorrhages [Figure 1]a and [Figure 1]b. No skin alterations were detected.
Figure 1: Axial DWI (a) and T2 FLAIR (b) images showing “star field” appearance of multiple hyperintense spots in the cerebral white matter, deep gray nuclei, splenium and centrum semiovale with a symmetric distribution. Chest CT (c) depicting diffuse bilateral pulmonary abnormalities with areas of patchy ground-glass infiltrates with “crazy-paving” pattern

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Fat embolism syndrome is usually characterized by hypoxemia, neurologic involvement, and petechial rash.[1]

In a recent review article on MRI patterns of cerebral fat embolism,[2] following sequences have been reported to improve the diagnostic process: T2-weighted, diffusion-weighted imaging (DWI), gadolinium contrast-enhanced and susceptibility-weighted imaging.

DWI sequences show the typical scattered cytotoxic edema, while T2-weighted images might reveal confluent signal alterations of the white matter. Enhancing lesions with vasogenic edema can be evidenced using T1-sequences after the administration of gadolinium. Finally, susceptibility-weighted imaging is sensitive for the detection of paramagnetic compounds such as petechial hemorrhages, which also represent a potential finding in this medical condition.

Stroke etiology is unclear. Fat globules might reach the arterial circulation through a patent foramen ovale, pulmonary capillaries or cause a biochemical inflammatory response leading to endothelial damage and brain–blood–barrier disruption.[3]

Statement of ethics

The patient has given written informed consent. The institute's committee on human research has approved the study protocol.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study was not sponsored. The authors report no disclosures.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Newbigin K, Souza CA, Torres C, Marchiori E, Gupta A, Inacio J, et al. Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings. Respir Med 2016;113:93-100.  Back to cited text no. 1
    
2.
Kuo KH, Pan YJ, Lai YJ, Cheung WK, Chang FC, Jarosz J. Dynamic MR imaging patterns of cerebral fat embolism: A systematic review with illustrative cases. Am J Neuroradiol 2014;35:1052-1057.  Back to cited text no. 2
    
3.
Bhatt AA, Brucker JL, Almast J. Beyond stroke-uncommon causes of diffusion restriction in the basal ganglia. Emerg Radiol 2018;25:87-92.  Back to cited text no. 3
    


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Online since 20th March '04
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