Susceptibility-Weighted Imaging Diagnosis of Cerebral Fat Embolism

A 75-year-old woman presented with hypoxemia, vomiting, and right facial weakness after falling. Head computed tomography (CT) demonstrated only a chronic left temporal infarct. Pelvis radiograph was negative for acute fracture. Within 24 hours, she developed bihemispheric coma and severe hypoxemic respiratory failure. Brain magnetic resonance imaging (MRI) demonstrated punctate acute infarcts scattered throughout both hemispheres. Fat embolism syndrome (FES) was suspected, despite a history of embolic stroke. Repeat brain MRI with susceptibility-weighted imaging (SWI) was consistent with FES and resolved diagnostic uncertainty (Figure 1). Subsequently, right hip CT revealed acute pelvic fractures. Petechiae emerged on the neck and conjunctiva 1 day later