Patient had multiple fractures of the pelvis and lower limbs. He was admitted to ER fully conscious, then 10 hours later he developed headache and a deteriorating conscious level.

Suspicion of cerebral fat embolism was made clinically before confirmation by MRI was considered.

The differential diagnosis include diffuse axonal injury which had similar MR characteristics.

The condition of the patient improved after few days and these foci resolved which is not the usual sequel of diffuse axonal injury.