A 64-year-old female with sickle cell (hemoglobin SC) disease and prior embolic strokes was admitted for vaso-occlusive pain crisis and developed sudden onset coma. Hyperacute brain MRI showed only small… Click to show full abstract
A 64-year-old female with sickle cell (hemoglobin SC) disease and prior embolic strokes was admitted for vaso-occlusive pain crisis and developed sudden onset coma. Hyperacute brain MRI showed only small areas of mismatch between diffusion weighted imaging (DWI) and T2 fluid attenuated inversion recovery (T2 FLAIR) sequences that were insufficient to explain her profoundly altered level of consciousness. Repeat MRI 24 hours later showed innumerable foci of restricted diffusion and petechial microhemorrhage, confirming a diagnosis of cerebral fat embolism due to sickle cell crisis.
               
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