Embolia Grasa Cerebral Subaguda: Valor Diagnóstico de la Secuencia de Susceptibilidad Magnética (SWI) en el Diagnóstico Diferencial con Lesión Axonal Difusa

Cerebral fat embolism is a serious vascular complication caused by the entry of fat globules into the cerebral circulation, causing vascular occlusion, inflammation, and endothelial damage. The most common causes include long bone fractures and surgical procedures such as intramedullary fixation. It is associated with a classic triad: respiratory failure, neurological symptoms, and skin petechiae. Magnetic resonance imaging usually shows a “starry sky” pattern in susceptibility sequences. A 28-year-old female patient presented with a fracture of the right femur. After intramedullary fixation, she presented with impaired alertness, petechial rash, and thrombocytopenia. Magnetic resonance imaging showed characteristic lesions, and a diagnosis of subacute cerebral fat embolism was established using Gurd's criteria. The syndrome is triggered by the entry of lipid particles that cause endothelial dysfunction. The SWI sequence becomes key during the subacute phase, allowing the detection of cortical and subcortical microbleeds that go unnoticed in conventional sequences. The combination of diffusion and susceptibility increases diagnostic sensitivity. The fundamental differential diagnosis is diffuse axonal injury, which is distinguished by the distribution of lesions and the absence of the classic triad. Intensive care management is essential for stabilization.