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Special Feature
November 1, 2004

Image of the Month—Diagnosis

Arch Surg. 2004;139(11):1258. doi:10.1001/archsurg.139.11.1258
Answer: Cerebral Fat Embolism

Figure. Magnetic resonance imaging shows scattered, spotty high-intensity areas on T2-weighted images.

The magnetic resonance imaging reported “increased densities in T2-weighted images in the corpus callosum and frontoparietal lobes, consistent with fat embolism” (Figure). The patient remained in a coma and on mechanical ventilation for 3 weeks. He woke up on day 25 and had a slow improvement of his mental status. He was discharged a few days later to a rehabilitation center.

Cerebral fat embolism may occur without any respiratory or other symptoms.13The cerebral manifestations may include confusion, lethargy, convulsions and coma. The history of the fractures, unexplained cerebral manifestations, and unexplained anemia and thrombocytopenia should alert the clinician to the possibility of cerebral fat embolism. The brain CT scan is usually normal. The magnetic resonance imaging is diagnostic and shows scattered, spotty high-intensity areas on T2-weighted images involving the cerebral white matter, corpus callosum, and basal ganglia.4The prognosis is usually good and most patients recover slowly.

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Submissions

The Editor welcomes contributions to the “Image of the Month.” Send manuscripts to Archives of Surgery, 1411 E 31st St, Oakland, CA 94602; (510) 437-4940; fax: (510) 534-5639; e-mail: archivesofsurgery@earthlink.net. Articles and photographs accepted will bear the contributor’s name. Manuscript criteria and information are per the “Instructions for Authors” for Archives of Surgery. No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations.

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Article Information

Correspondence:Demetrios Demetriades, MD, Department of Surgery, Room 1105, LAC+USC Trauma Center, 1200 North State St, Los Angeles, CA 90033 (demetria@usc.edu).

Accepted for Publication:April 3, 2003.

References
1.
Bracco  DFavre  JBJoris  RRavussin  A Fatal fat embolism syndrome: a case report. J Neurosurg Anesthesiol 2000;12221- 224
PubMedArticle
2.
Bardana  DRudan  JCervenko  FSmith  R Fat embolism syndrome in a patient demonstrating only neurologic symptoms. Can J Surg 1998;41398- 402
3.
Scopa  MMagatti  MRossito  P Neurologic symptoms in fat embolism syndrome: case report J. J Trauma 1994;36906- 908
PubMedArticle
4.
Simon  ADUlmer  JLStrottmann  JM Contrast-enhanced MRI of cerebral fat embolism: case report and review of the literature. AJNR Am J Neuroradiol 2003;2497- 101
PubMed
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