Sickle cell disease, fat embolism syndrome, and “starfield” pattern on MRI

A 45-year-old man with history of hemoglobin sickle cell disease (SCD) was admitted to the medical intensive care unit from an outside hospital with a several-day history of progressive chest and extremity pain, fever, tachycardia, tachypnea, and hypoxemia, and underwent red cell exchange for acute chest syndrome. He concomitantly developed progressive decline in mental status over several hours. His examination was notable for Glasgow Coma Scale 5 with no motor response to pain, and he was subsequently intubated.