Teaching Neuroimages: Cerebral Fat Embolism After Cemented Hip Replacement

Excerpt

A 75-year-old female patient underwent cemented total hip arthroplasty. After surgery, she presented with vegetative instability comprising hypertensive and tachycardic episodes, delayed awakening, and consecutive hypoactive delirium. Magnetic resonance imaging (MRI) after 3 days showed several bilateral punctual diffusion restrictions (Fig. 1a, b) and confluent T2-weighted lesions in the periventricular white matter (Fig. 1c). Susceptibility-weighted imaging disclosed uncountable bilateral spotty lesions in the white matter and watershed zones (Fig. 1f) as well as in the corpus callosum splenium (Fig. 1e), brainstem, and cerebellum (Fig. 1d). Clinical presentation and MRI pattern are characteristic for a fat embolism syndrome. …