Pre- and post-cerebral fat embolism (CFE) brain magnetic resonance imaging (MRI) with susceptibility-weighted sequences. Normal brain fluid-attenuated inversion recovery (FLAIR) MRI sequences performed 6 months before the index event (left side, A and B). Susceptibility-weighted imaging (SWI) sequences performed 24 hours after intubation. Multiple, punctuate, widespread, hypointense lesions are distributed in the cerebellum (C), basal ganglia, splenium of corpus callosum (D), and subcortical white matter bilaterally (E), (walnut kernel pattern). These alterations are consistent with the accumulation of haemosiderin in the context of diffuse microhaemorrhages from small-vessel occlusion by fat emboli. FLAIR images at 24 hours after intubation show scattered, monomorphic, hyperintense lesions in the deep grey structures (short arrow) and splenium of the corpus callosum (long arrow) not present in the pre-CFE brain imaging (A and B).