J Korean Neurosurg Soc.  2012 May;51(5):312-315. 10.3340/jkns.2012.51.5.312.

Magnetic Resonance Findings in Two Episodes of Repeated Cerebral Fat Embolisms in a Patient with Autologous Fat Injection into the Face

• Lee KM
• Kim EJ
• Jahng GH
• Chang DI

• KMID: 2066934
• DOI: http://doi.org/10.3340/jkns.2012.51.5.312

Abstract

We report magnetic resonance image (MRI) and magnetic resonance spectroscopy (MRS) findings in a patient of cerebral fat embolism (CFE) occurred in a 26-year-old woman after an autologous fat injection into the face. After initial neurologic symptom onset, MRI and MRS data were obtained two times to investigate repeated CFE. We obtained the MRS data in the two different time intervals and two different echo times to compare the lesions with normal brain parenchyma. The results of MRS data showed that a decrease in N-acetyl-aspartate, an increase in lactate and a very high early peak of free lipids between 0.9 and 1.4 ppm were obtained at the acute infarcted lesion as compared with normal brain parenchyma. In addition, these findings were more clearly detected on short echo time spectrum rather than long spectrum. A close relationship between the clinical manifestations and MRI and MRS findings of the brain can helpful to distinguish CFE with other conditions and to evaluate the cause materials of infarctions rather than conventional MRI or diffusion-weighted imaging.

Keyword

Cerebral fat embolism; Single-voxel MR spectroscopy; Point-resolved spectroscopy (PRESS); Autologous fat injection

MeSH Terms

Adult
Brain
Embolism, Fat
Female
Humans
Infarction
Lactic Acid
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Neurologic Manifestations
Lactic Acid

Figure

• 

  Fig. 1 Representative images obtained by DWI on two different time points. DWI shows high signal intensities in the right frontoparietal lobe (A) and low ADC value (B) at 3 hours after symptom onset. After 30 hours after symptom onset, DWI shows another high signal intensities in the right frontal lobe (C) correlation with low ADC value (D). DWI : diffusion-weighted imaging.

• 

  Fig. 2 Results of MR spectroscopy obtained two-different echo time (TE) with two-different regions-of-interest (ROIs) between normal brain parenchyma and acute to subacute infarctions after 30 hours after symptom onset. (B) Reveals ROI of mixed (hyperacute and acute) lesion of first and second attack of symptoms, and (A) reveals ROI of contralateral normal brain parenchyma. And, (D) reveals ROI of hyperacute infarction of second attack of symptom, and (C) reveals ROI of contralateral normal brain parenchyma. Probe press single voxel spectroscopy (TR=2000 msec/TE=40 msec). On short echo time spectrum (A1-D1), a strong resonance of free lipids are noted either normal and acute infarcted brain parenchyma. However, additional lactate peak is revealed only on acute infarction of right brain parenchyma. Probe press single voxel spectroscopy (TR=2000 msec/TE=144 msec). On long echo time spectrum (A2-D2), there is negative lactate values as compared with short echo time spectrum.

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