Cerebral fat embolism

Cerebral fat embolism (CFE) is one of a manifestations of fat embolism syndrome.

It typically occurs in patients with bony fractures (usually long bones of the lower limb).

Fat emboli usually reach the brain through a either right-to-left cardiac shunt or through an intact pulmonary circulation in those without a shunt 4.

Cerebral manifestations of fat embolism syndrome can be highly variable and non-specific: the symptoms spectrum includes headache, lethargy, irritability, delirium, stupor, convulsions, or coma. Most cases can occur as subclinical events. Concurrent pulmonary or cutaneous features may aid in diagnosis.

CT brain

The CT brain can be normal in most cases 8. The may be evidence of diffuse oedema with scattered low-attenuating areas and haemorrhage in some situations.

MRI brain
  • T2: may show multiple non-confluent areas of high signal intensity
  • DWI: may show bright spots on a dark background (“starfield pattern) corresponding to the region of T2 signal abnormality. 
  • SWI: may distinctly demonstrate multiple minute hypointense foci in the brain 12-13
  • T1: corresponding focal regions may show low T1 signal 9

For the "starfield pattern" on MRI, possible differential considerations include 6

Share article

Article information

rID: 29525
Section: Pathology
Synonyms or Alternate Spellings:
  • Cerebral fat embolism syndrome
  • Cerebral fat embolism (CFE)

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    There are multipl...
    Case 1
    Drag here to reorder.
  • Drag
    Case 2
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Drag
    Case 4
    Drag here to reorder.
  • Drag
    Case 5
    Drag here to reorder.
  • Drag
    Multiple small fo...
    Case 6
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.