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Images in Neurology
September 2009

Cerebral Fat Embolism: Susceptibility-Weighted Magnetic Resonance Imaging

Arch Neurol. 2009;66(9):1170. doi:10.1001/archneurol.2009.173

A 53-year-old man was injured in a car crash. At the scene of the crash, the patient was conscious without focal neurologic deficits. Emergency diagnosis revealed an open fracture of the left femur shaft, for which the patient underwent an internal fixation operation. Postoperatively, the patient was admitted to the general ward with a Glasgow Coma Scale score of 15. After 2 days, he presented with confused mentality and respiratory distress. Neurologic examination did not reveal focal deficits. Diffusion-weighted imaging showed numerous areas of restricted diffusion (Figure, A), and gradient-echo imaging showed dark signal intensities (Figure, B). Additionally, susceptibility-weighted imaging demonstrated more tiny signal voids (Figure, C) than were seen on the diffusion-weighted and gradient-echo imaging sequences. The patient's mental status recovered slowly. At 2-month follow-up, no residual neurological deficits were noted.