Presentation
Involved in a motor vehicle accident.
Patient Data
Non contrast CT study of the brain displayed minimal left posterior parietal acute subdural bleeding.
Multiple tiny foci of altered signal are seen scattered throughout both cerebral hemispheres mainly at basal ganglia, corona radiata and centrum semiovale, bilaterally. They display bright signal on DWI, low signal on ADC suggesting true diffusion restriction with faintly bright signal on T2 and FLAIR. There are also minimal left posterior parietal acute subdural hematoma as well as traumatic subarachnoid bleed in posterior parieto occipital regions bilaterally.
Case Discussion
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.
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