Fat embolism showing restriction on diffusion sequence in brain magnetic resonance imaging.

A 69 year-old female presented with bilateral amaurosis, headache, fever (38oC) and dyspnea two days after a liposuction and abdominoplasty. A bilateral papilledema was observed in the clinical examination, without other neurological changes. Her ESR was 60mm/h and her platelet count was low (55.000mm3). Brain MRI revealed restriction of diffusion sequence in the right globus pallidus and both retinas (Figure 1). At spinal tap opening pressure was 16cmH2O. CSF examination was normal. Angio-MRI of the head and neck were also normal. Both transthoracic and transesophagic ecoDoppler examinations of the heart, the latter tailored to exclude left-to-right shunt were normal. The whole investigation of coagulopathy, vasculitis and idiopathic intracranial hypertension were negative. The retinal angiofluoresceinography demonstrated papilledema with venous congestion and retinal hemorrhages and no change in the arterial bed (Figure 2). Patient was submitted to anticoagulation with enoxaparine 1mg/kg subcutaneous bid without reversal of amaurosis. Papilledema leading may be seen in increased intracranial pressure, inflammatory optic neuropathy, infiltrative optic