Related Experiment Video
Updated: Jun 18, 2026
13:10
Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016
Cerebral fat embolism and the "starfield" pattern: a case report
Amit Aravapalli1, James Fox, Christos Lazaridis
1Department of Internal Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA. aravapal@musc.edu
Cases Journal
|December 1, 2009
Summary
Fat embolism syndrome, a rare complication of fractures, can cause severe neurological issues. This case highlights the reversible nature of cerebral fat embolism, even with a "starfield" MRI pattern.
Area of Science:
- Neurology
- Trauma Medicine
- Radiology
Background:
- Fat embolism is common after long-bone fractures, but fat embolism syndrome (FES) is rare (0.9-2.2%).
- FES classically presents with respiratory distress, altered mental status, and petechial rash.
- Cerebral fat embolism (CFE) accounts for the neurological symptoms in FES.
Purpose of the Study:
- To report a case of CFE in a patient with non-head trauma.
- To illustrate the diagnostic utility of the "starfield" pattern on MRI in CFE.
- To emphasize the potential reversibility of neurological deficits in CFE.
Main Methods:
- Case report of a 19-year-old male with gunshot wounds.
- Neurological examination including Glasgow Coma Scale (GCS) assessment.
- Diffusion-weighted magnetic resonance imaging (MRI) of the brain.
Main Results:
- The patient presented with severe neurological impairment (GCS 4T) and signs of hyperreflexia.
- Brain MRI revealed a characteristic "starfield" pattern of punctate restricted diffusion.
- Neurological examination normalized at 10-week follow-up, with patient discharge.
Conclusions:
- CFE can occur in non-head trauma patients and present with severe neurological deficits.
- The "starfield" pattern on diffusion-weighted MRI is a key diagnostic finding for CFE.
- Neurological dysfunction in CFE is often reversible, even after significant initial insult.
Related Concept Videos
01:22Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
01:19Cerebral Edema l: Introduction
Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...
01:29Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...