[Diffusion-weighted MRI in early diagnosis of cerebral fat embolism syndrome]

Fat embolism syndrome (FES) is a potentially serious, but poorly diagnosed, complication in polytraumatized patients.

A 19 year-old male was admitted in our hospital with tibia and fibula fracture and no evidence of cranial traumatism or neurological symptoms. He underwent surgical reduction and internal fixation of the fractures. A few hours later, his consciousness suddenly deteriorated and he developed myoclonic jerks in his upper limbs. A computed tomography scan of the brain and lumbar puncture showed no abnormalities. The electroencephalograph demonstrated frontotemporal spike-wave activity with tendency to generalization. Diagnosed of epileptic status, he was treated with intravenous valproic acid. The myoclonia disappeared and the patient regained consciousness. A magnetic resonance imaging (MRI) scan of the head performed 68 h later showed multiple high intensity signals throughout the white matter which were seen on the diffusion weighted images as bright spots. Echocardiography did not demonstrate patent oval foramen. The patient was discharged from hospital without sequels and with the diagnosis of FES. The control MRI at 5 weeks showed the persistence of the lesions without restriction in diffusion sequence.

FES is a frequent complication that is underdiagnosed and potentially serious. It should be considered in polytraumatized patients. The manipulation performed in the orthopedic reduction seems to have played an important role in the patient's condition. MRI allows for the diagnosis and characterization of acute lesions in the central nervous system, ruling out other etiologies.