Reversible cytotoxic cerebral edema in cerebral fat embolism

Abstract

We present a case of cerebral fat embolism (CFE) that demonstrated evidence of diffuse white matter cytotoxic edema on diffusion-weighted magnetic resonance imaging, in addition to punctate hyperintensities on T2-weighted and diffusion-weighted imaging. The case suggests that CFE represents a combination of occlusive arteriolar disease and secondary neurotoxicity.

Fig 1.

A–C, Axial T2-weighted images 7 days after the ictus, demonstrating punctate hyperintensities throughout the white matter, on a background of slightly increased white matter signal intensity consistent with edema.

Fig 2.

A–C, Axial diffusion-weighted images (DWI) at corresponding sections. Marked signal intensity hyperintensity throughout the white matter demonstrates reduced diffusivity consistent with cytotoxic edema. Punctate areas of greater signal intensity correspond to the lesions shown on T2-weighted images.

Fig 3.

A–C, Axial apparent diffusion coefficient (ADC) maps at corresponding sections, demonstrating reduced diffusivity as low signal intensity throughout the cerebral white matter.

Fig 4.

Axial T2-weighted (A–C) and diffusion-weighted images (DWI) (D–F), and apparent diffusion coefficient (ADC) maps (G–I) at corresponding sections 30 days after the ictus. Scattered punctate hyperintensities consistent with lacunar infarcts are present in areas that correlate with focal areas of signal intensity abnormality in the previous figures. The generalized mild T2 hyperintensity and reduced DWI and ADC map diffusivity have resolved.