title: The "starfield" pattern of cerebral fat embolism from bone marrow necrosis in sickle cell crisis.
abstract: Sickle cell disease may manifest with cerebrovascular and systemic complications. Sickle crisis that results in avascular necrosis of long bones with resultant cerebral fat embolism syndrome is rare and has a characteristic "starfield" pattern on MRI. This "starfield" MRI pattern should raise suspicion for sickle cell crisis in patients without a known history of the disease, which can lead to earlier sickle cell red blood cell exchange transfusion and treatment. We present a case of a male who presented emergently with acute seizure, coma with a characteristic MRI pattern, which lead to the diagnosis of avascular bone marrow necrosis and cerebral fat embolism syndrome from sickle cell crisis.
authors.affiliation: Department of Neurology, Jacksonville, FL, USA ; Department of Neurology, Jacksonville, FL, USA.
authors.forename: Laxmi P
authors.initials: LP
authors.lastname: Dhakal
authors.affiliation: Department of Laboratory Medicine and Pathology, Jacksonville, FL, USA.
authors.forename: Kirk
authors.initials: K
authors.lastname: Bourgeois
authors.affiliation: Department of Neurology, Jacksonville, FL, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Barrett
authors.affiliation: Department of Neurology, Jacksonville, FL, USA ; Department of Critical Care at Mayo Clinic, Jacksonville, FL, USA ; Department of Neurosurgery, Jacksonville, FL, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Freeman
keywords: bone marrow necrosis; cerebral fat embolism syndrome; magnetic resonance imaging (MRI); seizure; sickle cell disease
references.citation: Clin Radiol. 2008 Jan;63(1):59-70
references.pmid: 18068791
references.citation: J Emerg Trauma Shock. 2011 Apr;4(2):309-12
references.pmid: 21769222
references.citation: Injury. 2011 Sep;42 Suppl 4:S6-S10
references.pmid: 21939804