Subarachnoid and intraventricular dissemination of fat secondary to intrathecal pain pump

Authors

  • Otavio Augusto Ferreira Dalla Pria Department of Radiology, University of Iowa Hospitals and Clinics, USA
  • Christine M Gill Department of Neurology, University of Iowa Hospitals and Clinics, USA
  • Krishnakumari Ashwinbhai Modi Department of Radiology, University of Iowa Hospitals and Clinics, USA
  • Leonardo F. Freitas Division of Clinical Neuroradiology, Department of Radiology, Baptist Health South Florida, USA :Florida International University (FIU), Herbert Wertheim College of Medicine, USA
  • Nitesh Shekhrajka Department of Radiology, University of Iowa Hospitals and Clinics, USA

DOI:

https://doi.org/10.3941/jrcr.5676

Abstract

Radiologists frequently encounter intracranial fat in daily practice, typically representing physiologic or anatomic variations such as small fat deposits in the falx or well-known entities such as dermoid cysts, intracranial lipomas, and post-surgical/procedural dissemination after intracranial surgery and fat grafting. Among rare causes are subarachnoid and intraventricular migration of fat after spinal trauma or surgery.

A rarer entity, intracranial migration of fat following intrathecal pain pump placement, has been reported in only two previous cases in the English literature. With this article, we present the third documented case to raise awareness of this potential differential diagnosis for subarachnoid fat dissemination, particularly in the absence of a history of trauma or intracranial surgery. Given that the etiological source may be distant from the imaging field of view, it can easily be overlooked in the differential diagnosis.

51 years old female with known cavernous malformations, prior MRI brain with contrast. A, B and C: Axial Susceptibility weighted images (SWI) showing multiple foci of blooming in the supratentorial brain parenchyma and brain stem corresponding to patient’s known cavernous malformations (white arrows). D: Axial T2 sequence showing typical “popcorn appearance with central T2 hyperintensity and peripheral T2 dark rim (red arrows). E: Axial T1 and F: Axial T1 post contrast MPRAGE images showing mild intrinsic T1 hyperintensity within the lesions representing subacute blood products with questionable subtle enhancement (red arrows).

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Published

2025-03-31

Issue

Vol. 19 No. 3 (2025)

Section

Neuroradiology

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