Cerebral Fat Embolism Syndrome Followed by Magnetic Resonanse Imaging from The Acute Stage

Cerebral fat embolism (CFE) is a serious complication of long-bone fractures. We reported a case of CFE observed throughout the clinical course by magnetic resonance imaging (MRI) studies. A 23-year-old man suffered a left femoral fracture in a traffic accident and lapsed into a coma 23 hours after injury. Brain computed tomography (CT) did not show any abnormality 8 hours after coma, but MRI showed multiple high-intensity spotty lesions in cerebral white matter in T2 weighted images (T2WI). Four days after onset, these positive lesions became much clearer and spread. Although most disappeared in the subacute clinical stage, local highintensity lesions were still observed in T2WI, apparently local brain edema and ischemic infarctions. CFE is reported to exert 3 characteristic manifestations -- local brain edema, ischemic infarction, and hemorrhagic infarction. These patterns and localization appear to be correlated with clinical outcome. We conducted MRI studies to clarify the status and location of CFE, and found that T2WI, inversion recovery T1 (IRT1) and gradient echo T2*weighted images (T2*WI) studies are useful in CFE detection and status assessment.