Presentation
Fall off a ladder with injuries including a femur fracture, left acetabular/pelvic fracture. Taken to OR for external fixation of left femur fracture with intraoperative hypotension. Initially had GCS of 15, but 3 days later, patient progressively had decreased mental status with posturing.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
No gross abnormality.
Scattered foci of restricted diffusion/FLAIR signal abnormality are demonstrated in the bilateral centrum semiovale. Diffusion restriction with blooming artifact on GRE/SWI is seen in the splenium of the corpus callosum.
Sagittal body CT in bone windows: Left acetabular pelvic fracture
Left femur AP plain radiograph: Comminuted, mildly displaced left mid-shaft femur fracture
Case Discussion
CT was initially negative. On brain MRI, the findings were initially called watershed infarcts with diffuse axonal injury. However, the clinical history of multiple bony fractures and latent interval of several days seemed more consistent with cerebral fat embolism, which has a much better prognosis.
- Cerebral fat embolism:
- Latent interval: hours to 4 days
- Pulmonary and cutaneous manifestation: hypoxemia and petechia
- SWI: cerebral and cerebellar white matter, splenium of corpus callosum
- Prognosis: Often favorable
- DAI:
- Latent interval: none
- Pulmonary and cutaneous manifestation: None
- SWI: Cerebral gray-white matter junction, splenium of corpus callosum, dorsolateral brainstem
- Prognosis: Less favorable
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