Subarachnoidal fat droplet deposition and fat embolism syndrome

Description

A 68-year-old woman presenting with multiple rib, spine fractures, femur and ankle fractures after a fall from height was admitted. Although she responded to verbal orders appropriately at the time of admission, her consciousness drastically deteriorated after 4.5 hours of the accident. She presented a decerebrate posture and acute respiratory failure with bilateral diffuse infiltration consistent with non-cardiogenic pulmonary oedema, requiring mechanical ventilation. She was also complicated with decreased platelet count, suggesting fat embolism syndrome (FES). At the time of the acute deterioration, brain CT demonstrated no gross abnormality, except for fat droplet in the subarachnoidal space (figure 1). On the third day, MRI showed numerous pinpoint hyperintense foci in the grey and white matter of the cerebral and cerebellar hemispheres on diffusion-weighted images (figure 2), consistent with the 'starfield appearance'. Right to left shunt, including patent foramen ovale, was not evident by transthoracic...

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