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Journal articles on the topic 'Starfield pattern'

Author: Grafiati

Published: 4 June 2025

Last updated: 15 July 2025

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1

Josan, EnambirS, GabrielA Zaietta, and GirendraV Hoskere. "The Devastating Starfield Pattern of Cerebral Fat Embolism." Neurology India 69, no. 2 (2021): 538. http://dx.doi.org/10.4103/0028-3886.314561.

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2

Brun-Vergara, María Lucía, and Daniel Montes. "MRI of Cerebral Fat Embolism: Type 1 Starfield Pattern." Radiology 297, no. 2 (2020): 303. http://dx.doi.org/10.1148/radiol.2020202212.

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3

Kang, Jennifer H., Charles William Hargett, Theresa Sevilis, and Matthew Luedke. "Sickle cell disease, fat embolism syndrome, and “starfield” pattern on MRI." Neurology: Clinical Practice 8, no. 2 (2018): 162–64. http://dx.doi.org/10.1212/cpj.0000000000000443.

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4

Peters, S., T. Singh, D. Tirschwell, and S. Khot. "P.004 Diagnostic evaluation of cerebral fat embolism: single center retrospective review." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, S2 (2017): S15. http://dx.doi.org/10.1017/cjn.2017.89.

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Background: Cerebral Fat Embolism (CFE) is a rare though potentially devastating complication of orthopedic injury which can present with neurologic deterioration. Although specific findings have been described, definitive diagnosis of CFE remains challenging. Methods: Retrospective chart review from a major U.S. trauma hospital. Results: Of 33 patients with CFE, all had long bone fractures, 15 had rib fractures, and 16 occurred following orthopedic surgery for long bone fracture. Cutaneous petechiae were documented in 21%. Diagnostic brain MRI was performed in 26 patients. MRI revealed diffusion-restricting lesions in 24 (92%), with 17 (65%) demonstrating the classic “starfield” pattern, and 14 (54%) with hypointense signal on blood sensitive sequences. Transcranial Doppler (TCD) revealed active microemboli in 9 of 17 (53%) cases. Ophthalmologic consultation occurred in 13 with 9 patients found to have retinal hemorrhage or cotton wool spots suggestive of Purtscher or Purtscher-like retinopathy. “Starfield” pattern on MRI was seen in all 9 patients with retinal findings. TCD microemboli were not associated with retinal findings. Conclusions: The optimal diagnostic workup of CFE is complicated by confounding conditions, the unknown sensitivity of diagnostic modalities, and the unclear implications of findings on treatment and outcome. Nonetheless, brain MRI, TCD and ophthalmologic evaluation should be considered in all suspected CFE patients.

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5

Parizel, P. M., H. E. Demey, G. Veeckmans, et al. "Early Diagnosis of Cerebral Fat Embolism Syndrome by Diffusion-Weighted MRI (Starfield Pattern)." Stroke 32, no. 12 (2001): 2942–44. http://dx.doi.org/10.1161/str.32.12.2942.

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6

Manorenj, Sandhya, Sara Sravan Kumar, Sravan Kumur Marupaka, and Farah Naaz. "Isolated Starfield Pattern and the Type 1 Cerebral Fat Microembolism: A Radiological Perspective." Annals of Indian Academy of Neurology 28, no. 3 (2025): 435–36. https://doi.org/10.4103/aian.aian_1042_24.

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7

Dhakal, Laxmi P., Kirk Bourgeois, Kevin M. Barrett, and William D. Freeman. "The “Starfield” Pattern of Cerebral Fat Embolism From Bone Marrow Necrosis in Sickle Cell Crisis." Neurohospitalist 5, no. 2 (2014): 74–76. http://dx.doi.org/10.1177/1941874414554300.

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8

Shacklock, Emma, Andrew Gemmell, and Nigel Hollister. "Neurological effects of fat embolism syndrome: A case report." Journal of the Intensive Care Society 18, no. 4 (2017): 339–41. http://dx.doi.org/10.1177/1751143717718664.

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Fat embolism syndrome is a serious multi-system pathology which classically affects the respiratory system, neurological system and causes a petechial rash. We present the case of a 20-year-old farmer who developed fat embolism syndrome following a traumatic femoral fracture. Features developed within 24 h of injury and necessitated a prolonged stay in Intensive Care. He exhibited significant signs of cerebral fat embolism syndrome including coma and seizures but went on to make full functional recovery. Magnetic resonance imaging is the recommended imaging modality for patients with suspected cerebral fat embolism. In this case, computerised tomography was inconclusive, but magnetic resonance imaging demonstrated the “starfield pattern” of multiple high signal foci on a dark background. Supportive treatment of fat embolism syndrome is required in an appropriate setting, such as High Dependency or Intensive Care, for patients at risk of hypoxia or neurological deterioration. Despite major neurological involvement of fat embolism syndrome, full recovery is described by several cases including ours.

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9

Clarke, Andrew, Wilson Vallat, and Timothy Kleinig. "087 Cerebral fat embolism in a case of endoscopic oesophageal dilatation." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (2018): A35.2—A35. http://dx.doi.org/10.1136/jnnp-2018-anzan.86.

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IntroductionFat Embolism Syndrome (FES) is rare, usually occurring in the setting of long bone fractures or trauma. Furthermore, isolated neurological form or pure cerebral fat embolism (CFE) is an atypical presentation. The authors are not aware of any previously documented cases of endoscopy related CFE without accompanying trauma.CaseA 61 year old male presented for an elective endoscopy with dilatation for known oesophageal ulcer with stricturing. In post-operative recovery one hour post dilatation, he was found to have left sided weakness, aphasia and right fixed lateral gaze, NIHSS score of 18. He subsequently developed generalised tonic clonic seizures with reduced sensorium requiring intubation. CT brain was normal. MRI brain the following day showed bi-hemispheric punctate scattered white matter diffusion weighted restrictions (starfield pattern) characteristic for CFE. There were no signs of respiratory distress or petechial skin rash. Cardiac monitoring and transthoracic echocardiography with bubble test were normal.ConclusionThis case highlights a rare presentation of an uncommon syndrome, in a previously unidentified patient cohort, and the most appropriate investigation required to diagnose CFE.

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10

Aminian, KS. "P.057 A case of cerebral fat embolism in the absence of right-to-left shunt." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 50, s2 (2023): S74. http://dx.doi.org/10.1017/cjn.2023.161.

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Background: A 64-year-old man underwent an elective right total hip arthroplasty. Post-operatively, his GCS was 6, despite reversal of anesthetic agents. His toes were upgoing bilaterally. He did not have other focal neurologic deficits. He was intubated for airway protection. His only vascular risk factor was hypertension. Methods: [Case Report]Results: A CT/CTA/CTP head was unremarkable. A 1.5T MRI showed a few tiny, bihemispheric, embolic infarcts. These were not significant enough to account for his decreased level of consciousness. His blood work did not show evidence of coagulopathy. A subsequent 3T MRI demonstrated widespread, tiny embolic infarcts in a starfield pattern, consistent with cerebral fat embolism. A transesophageal echocardiogram with bubble study failed to demonstrate a right-to-left shunt. By post-operative day 11, he returned to his neurological baseline. Conclusions: A high degree of suspicion is required to diagnose cerebral fat embolism. There are reports of cerebral fat embolism in the absence of right-to-left shunt. The proposed mechanism is physiologic stress leading to systemic release of free fatty acids and inflammatory mediators, which damage capillary beds and disrupt the blood-brain barrier. This diagnosis has important prognostic implications as fat vacuoles deform easily and deficits are typically more reversible than those occurring with other embolic events.

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11

Ajayakumar, Thankappan, Nasimudeen Nizaj, Thomas Annie, and T. Padmakumari Lekshmi. "Isolated Cerebral Fat Embolism Syndrome in a Polytrauma Patient with Complete Recovery – A Case Report." Journal of Orthopaedic Case Reports 12, no. 4 (2022): 23–26. http://dx.doi.org/10.13107/jocr.2022.v12.i04.2750.

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Introduction: Isolated cerebral fat embolism syndrome (FES) is a rare complication that occurs within the first 3 days of the initial insult. We report a case of multiple long bone fractures with isolated cerebral FES, despite undergoing early total care with definitive fixation. Case Presentation: A 22-year-old female presented with type IIIA open femur shaft fracture on the right side (AO 32B2), closed femur shaft fracture (AO 32B2), comminuted patella fracture on the left side (AO 34C3), and undisplaced mandible fracture. She had a normal sensorium with a Glasgow Coma Scale (GCS) of E4V5M6. A whole body computed tomography (CT) scan was done to rule out other injuries. All initial scans were normal. After about 6 h in the ICU, she was noticed to have disconjugate gaze and was answering in monosyllables. A repeat CT scan of the brain was normal. The early total care and definitive fixation with titanium intramedullary nails for femur fractures and tension band wiring for patella was done under general anesthesia. On 1st post-operative day (POD), her GCS dropped to E1VTM1. On the 3rd POD, she developed decerebrate rigidity and generalized tonic clonic seizures. Fundoscopic examination showed multiple fat globules along the vessel in the entire field of both eyes. Since there were no other signs of FES in the lungs or on the skin, an MRI brain was done which revealed a hyperintensive starfield pattern on diffusion-weighted images, suggestive of cerebral fat embolism (CFE). At 4 weeks, her upper limb and lower limb muscle power improved. By 2 months, she was mobilized with support. Her Mini-Mental State Examination showed no cognitive impairment. At the latest follow-up at 1 year, her fractures are completely healed and she has no neurological or functional impairment. Conclusion: We must always suspect isolated cerebral FES as a diagnosis in polytrauma patients even when the classical findings are not present. MRI compatible implants have to be used as far as possible as MRI may be required to confirm the diagnosis of CFE. The early total care with definitive fixation and supportive treatment helped us in this patient’s complete recovery without cognitive impairment.

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12

Velasco, Sofia, Andrés Vasquez, and Angela Guarnizo. "Cerebral fat embolism: two imaging patterns beyond starfield pattern." Neurological Sciences, July 9, 2025. https://doi.org/10.1007/s10072-025-08339-9.

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13

Giyab, Omar, Bendegúz Balogh, Péter Bogner, Orsi Gergely, and Arnold Tóth. "Microbleeds show a characteristic distribution in cerebral fat embolism." Insights into Imaging 12, no. 1 (2021). http://dx.doi.org/10.1186/s13244-021-00988-6.

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AbstractThis systematic review aims to test the hypothesis that microbleeds detected by MRI are common and show a characteristic pattern in cerebral fat embolism (CFE). Eighty-four papers involving 140 CFE patients were eligible for this review based on a systematic literature search up to 31 January 2020. An additional case was added from hospital records. Patient data were individually scrutinised to extract epidemiological, clinical and imaging variables. Characteristic CFE microbleed pattern resembling a “walnut kernel” was defined as punctuate hypointensities of monotonous size, diffusely located in the subcortical white matter, the internal capsule and the corpus callosum, with mostly spared corona radiata and non-subcortical centrum semiovale, detected by susceptibility- or T2* weighted imaging. The presence rate of this pattern and other, previously described MRI markers of CFE such as the starfield pattern and further diffusion abnormalities were recorded and statistically compared. The presence rate of microbleeds of any pattern, the “walnut kernel microbleed pattern”, diffusion abnormality of any pattern, the starfield pattern, and cytotoxic edema in the corpus callosum was found to be 98.11%, 89.74%, 97.64%, 68.5%, and 77.27% respectively. The presence rate between the walnut kernel and the starfield pattern was significantly (p < 0.05) different. Microbleeds are common and mostly occur in a characteristic pattern resembling a “walnut kernel” in the CFE MRI literature. Microbleeds of this pattern in SWI or T2* MRI, along with the starfield pattern in diffusion imaging appear to be the most important imaging markers of CFE and may aid the diagnosis in clinically equivocal cases.

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14

Otter, L. A. S. den, B. Vermin, and M. Goeijenbier. "Fat embolism syndrome in a patient that sustained a femoral neck fracture: A case report." Frontiers in Medicine 9 (December 8, 2022). http://dx.doi.org/10.3389/fmed.2022.1058824.

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BackgroundWe present a case of a patient with a femoral neck fracture that shows neurological impairment and respiratory distress 1 day after trauma, caused by the Fat Embolism Syndrome with the presence of Cerebral Fat Embolisms.Case summaryA 75 year old female remained unresponsive after a hemi arthroplasty was performed because of a 1 day old femoral neck fracture. She rapidly developed respiratory insufficiency and an obstructive shock with right ventricle dilatation on transthoracic echocardiography. The diffusion-weighted MRI brain images showed the “Starfield” pattern, a radiologic phenomenon typical for FES. During 3 weeks of ICU admission the neurologic state slowly ameliorated.ConclusionThe rare FES is a clinical diagnosis with mainly respiratory, neurologic and dermatologic symptoms in the setting of a trauma patient. Fat embolisms are able to reach the brain without the presence of a patent foramen ovale to cause neurological symptoms. Diagnosing FES remains challenging but the distinctive “Starfield” pattern on MRI scans is promising.

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15

Aravapalli, Amit, James Fox, and Christos Lazaridis. "Cerebral fat embolism and the "starfield" pattern: a case report." Cases Journal 2, no. 1 (2009). http://dx.doi.org/10.1186/1757-1626-2-212.

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16

Xie, Vivien, Dana Harrar, Jonathan Murnick, Diana Bharucha-Goebel, and Kuntal Sen. "Starfield Pattern on Brain MRI in a Patient with Duchenne Muscular Dystrophy." Neuropediatrics, August 2, 2023. http://dx.doi.org/10.1055/a-2146-6989.

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17

Garg, Divyani, Ayush Agarwal, Achal K. Srivastava, and Ajay Garg. "Brain imaging inspired by outer space." Practical Neurology, July 7, 2023, pn—2023–003787. http://dx.doi.org/10.1136/pn-2023-003787.

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Medicine has many vividly named signs. We have compiled a list of radiological cerebral signs inspired by phenomena in outer space. These range from the well-known ‘starry sky’ appearance of neurocysticercosis or tuberculomas, to various lesser known signs including the ‘starfield’ pattern of fat embolism; ‘sunburst’ sign of meningiomas; ‘eclipse’ sign of neurosarcoidosis; ‘comet tail’ sign of cerebral metastases; ‘Milk Way’ sign of progressive multifocal leukoencephalopathy; ‘satellite’ and ‘black hole’ sign of intracranial haemorrhage; ‘crescent’ sign of arterial dissection and ‘crescent moon’ sign of Hirayama disease.

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18

Badir, J., J. Thorson, and T. Ranasinghe. "Abstract 079: Cerebral Fat Embolism with “Starfield Pattern on MRI Brain” Secondary to Sickle Cell Beta Thalassemia." Stroke: Vascular and Interventional Neurology 4, S1 (2024). https://doi.org/10.1161/svin.04.suppl_1.079.

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19

Masooma, Hashmi. "A case report of TRAP Sequence with Preeclampsia and Review of Literature." June 14, 2021. https://doi.org/10.5281/zenodo.5081935.

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Abstract Cerebral fat embolism (CFE) is highly associated with long bone fractures however incidence is low. Imaging features show spectrum of findings. A 23-year-old male was admitted with right femur fracture in a road traffic accident. Surgically operated patient developed deteriorating confusion and altered sensorium. Subsequent MRI of the brain showed innumerable punctate hyperintense lesions on T2- and T2weighted, FLAIR and restricted diffusion on DW consistent with "starfield" pattern. After 27days hospital stay with supportive therapy patient regained complete neurological function and was discharged home. Diagnosis of CFE remains a challenge because of its various presentations, reversibility and distribution of the brain lesions. MR imaging of the brain by using T2-weighted, (FLAIR), diffusion weighted, and susceptibility-weighted imaging has been applied to CFE and has improved the ability to make an early diagnosis.

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20

Brig, (R) Dr Tariq Mehmood Mirza. "A Case Report of Dynamic Mr Imaging of Cerebral Fat Embolism." June 14, 2021. https://doi.org/10.5281/zenodo.5081947.

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Abstract Cerebral fat embolism (CFE) is highly associated with long bone fractures however incidence is low. Imaging features show spectrum of findings. A 23-year-old male was admitted with right femur fracture in a road traffic accident. Surgically operated patient developed deteriorating confusion and altered sensorium. Subsequent MRI of the brain showed innumerable punctate hyperintense lesions on T2- and T2weighted, FLAIR and restricted diffusion on DW consistent with "starfield" pattern. After 27days hospital stay with supportive therapy patient regained complete neurological function and was discharged home. Diagnosis of CFE remains a challenge because of its various presentations, reversibility and distribution of the brain lesions. MR imaging of the brain by using T2-weighted, (FLAIR), diffusion weighted, and susceptibility-weighted imaging has been applied to CFE and has improved the ability to make an early diagnosis.

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21

Cibulas, Megan A., Eddy H. Carrillo, Seong K. Lee, and Andrew A. Rosenthal. "Cerebral Fat Embolism via a Patent Foramen Ovale." American Surgeon, March 25, 2022, 000313482210822. http://dx.doi.org/10.1177/00031348221082270.

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Fat embolism syndrome (FES) is a multisystem process predominantly secondary to long bone/pelvic fractures and orthopedic procedures. A 19-year-old man presents after motor vehicle collision with trace right pneumothorax, right grade 3 kidney laceration, left pubic rami, and right femoral shaft fractures. Right femur closed reduction ensued and he underwent intramedullary nailing; his other injuries were managed nonoperatively. Upon awakening in recovery, he was newly aphasic. Despite negative repeat CT brain, he continued to worsen and became tachycardic and hypoxemic. MRI/MRA brain demonstrated innumerable bilateral frontal, parietal, and occipital acute ischemic infarcts in a starfield pattern. Echocardiogram revealed a PFO. With supportive care, he improved and was discharged with planned outpatient PFO closure. One month later, he had complete symptom resolution with return to neurologic baseline. FES is a potentially devastating condition which may include cerebral fat embolism (CFE) with outcomes varying widely from mortality to complete recovery.

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22

Payne, Rebecca Elizabeth, Francesca Dakin, Ellen MacIver, et al. "What are the challenges to quality in modern, hybrid general practice? A multi-site longitudinal study." British Journal of General Practice, August 8, 2024, BJGP.2024.0184. http://dx.doi.org/10.3399/bjgp.2024.0184.

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Background Since 2022, general practice has shifted from responding to the acute challenges of COVID-19 to restoring full services, using remote and digital modalities as well as traditional in-person care. Aim To examine how quality domains are addressed in contemporary UK general practice. Design and setting Multi-site, mostly qualitative longitudinal case study, placed in national policy context. Method Data were collected from longitudinal ethnographic case studies of 12 general practices (2021-2023); multi-stakeholder workshops; stakeholder interviews; patient surveys; official reports; and publicly-accessible patient experience data. Data were coded thematically and analysed using Institute of Medicine domains, Starfield’s core features of primary care and sociological and socio-technical theories. Results Quality efforts in UK general practice occur within cumulative impacts of financial austerity, loss of resilience, increasingly complex patterns of illness and need, a diverse and fragmented workforce, infrastructure unfit for purpose, and distanciated ways of working. Providing the human elements of traditional general practice is difficult and sometimes impossible. Triage systems designed to increase efficiency have introduced new forms of inefficiency and compromised other quality domains. Long-term condition management varies in quality; amidst some convenience gains, some practices rely on remote, asynchronous data entry by patients and fragmented care by underqualified staff. Measures to mitigate digital exclusion do not compensate for extremes of structural disadvantage. Many staff are stressed and demoralised. Conclusion Contemporary hybrid general practice features changes with the unintended effect of dehumanising, compromising and fragmenting care. Risks to patients and the core values of general practice should be urgently addressed.

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