Diagnostic challenge in intensive care: massive cerebral fat embolism, lessons from a case report.
PDF (Spanish)
HTML (Spanish)

Keywords

Fat embolism.
brain
nervous system
shock
magnetic resonance imaging

Categories

How to Cite

1.
Diagnostic challenge in intensive care: massive cerebral fat embolism, lessons from a case report. Rev Arg de Ter Int. [Internet]. 2025 Oct. 22 [cited 2025 Dec. 5];42(1). Available from: https://revista.sati.org.ar/index.php/MI/article/view/928

Abstract

Fat embolism occurs as a result of traumatic or non-traumatic injury, where fat globules from adipose tissue enter the circulation and disperse throughout the body, leading to a wide range of clinical manifestations depending on the affected organ. This article presents a clinical case of cerebral fat embolism syndrome, with a diagnostic suspicion guided by major and minor clinical criteria, complemented by brain MRI, which plays a crucial role in ruling out differential diagnoses compatible with its characteristic "starfield pattern," also seen in diffuse axonal injury or demyelinating diseases. Diagnostic suspicion should be based on clinical history, lack of response to conventional treatments, and persistence of neurological symptoms after ruling out other conditions.

PDF (Spanish)
HTML (Spanish)

References

Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br [Internet]. 1970 Nov;52(4):732–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/5487573

Roberts CS, Hartley B, Carlson J, Seligson D. Diagnosis and Treatment of Complications.

C T, C K, CG M. Fat Embolism Syndrome – A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management. Malays Orthop J [Internet]. 2021 Mar 1;15(1):1–11. Available from: https://www.morthoj.org/2021/v15n1/fat-embolism-syndrome.pdf

Müller C, Rahn BA, Pfister U, Meinig RP. The incidence, pathogenesis, diagnosis, and treatment of fat embolism. Orthop Rev. 1994 Feb;23(2):107–17.

Godoy DA, Di Napoli M, Rabinstein AA. Cerebral Fat Embolism: Recognition, Complications, and Prognosis. Neurocrit Care [Internet]. 2018 Dec 20;29(3):358–65. Available from: http://link.springer.com/10.1007/s12028-017-0463-y

Singh A, Davis AP, Taylor B, Peters S, Tirschwell D, Longstreth WT, et al. Cerebral fat embolism syndrome at a single trauma center. Journal of Stroke and Cerebrovascular Diseases [Internet]. 2022 Dec 1;31(12):106794. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1052305722004888

Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br. 1974 Aug;56B(3):408–16.

Kwiatt M, Seamon M. Fat embolism syndrome. Int J Crit Illn Inj Sci [Internet]. 2013;3(1):64. Available from: https://journals.lww.com/10.4103/2229-5151.109426

Morales-Vidal SG. Neurologic Complications of Fat Embolism Syndrome. Curr Neurol Neurosci Rep [Internet]. 2019 Mar 20;19(3):14. Available from: http://link.springer.com/10.1007/s11910-019-0928-9

Lee SC, Yoon JY, Nam CH, Kim TK, Jung KA, Lee DW. Cerebral Fat Embolism Syndrome After Simultaneous Bilateral Total Knee Arthroplasty. J Arthroplasty [Internet]. 2012 Mar;27(3):409–14. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0883540311002816

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. American Journal of Neuroradiology [Internet]. 2014 Jun 1;35(6):1052–7. Available from: http://www.ajnr.org/cgi/doi/10.3174/ajnr.A3605

Kokatnur L, Rudrappa M, Khasawneh K. Cerebral fat embolism: Use of MR spectroscopy for accurate diagnosis. Ann Indian Acad Neurol [Internet]. 2015 Apr 1;18(2):252. Available from: http://www.annalsofian.org/text.asp?2015/18/2/252/150604

Hoiland RL, Griesdale DE, Gooderham P, Sekhon MS. Intraparenchymal Neuromonitoring of Cerebral Fat Embolism Syndrome. Crit Care Explor [Internet]. 2021 May 12;3(5):e0396. Available from: https://journals.lww.com/10.1097/CCE.0000000000000396

Kim HJ, Lee CH, Lee SH, Moon TY. Magnetic Resonance Imaging and Histologic Findings of Experimental Cerebral Fat Embolism. Invest Radiol [Internet]. 2003 Oct 1;38(10):625–34. Available from: https://journals.lww.com/00004424-200310000-00003

Bodanapally UK, Shanmuganathan K, Saksobhavivat N, Sliker CW, Miller LA, Choi AY, et al. MR imaging and differentiation of cerebral fat embolism syndrome from diffuse axonal injury: application of diffusion tensor imaging. Neuroradiology [Internet]. 2013 Jun;55(6):771–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23515659

Stoeger A, Daniaux M, Felber S, Stockhammer G, Aichner F, zur Nedden D. MRI findings in cerebral fat embolism. Eur Radiol [Internet]. 1998 Nov 23;8(9):1590–3. Available from: http://link.springer.com/10.1007/s003300050592

Nolte WJ, Olofsson T, Scherstén T, Lewis DH. Evaluation of the Gurd test for fat embolism. J Bone Joint Surg Br [Internet]. 1974 Aug;56B(3):417–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/4425008

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2025 Geovanny Gabriel Garcia Cox