[Thrombus of the aortic arch: an unusual pathology in intensive care]

A 54-year-old patient was admitted to the intensive care unit for voluntary drug intoxication with zolipidem (Stilnox), dimenhydrinate (Mercalm), and oestradiol 17 beta (Oromone). Four hours after the admission the patient was comatose. Cerebral computerized tomodensitometry demonstrated multiple zones of ischaemia. Transoesophageal echocardiography was performed 12 hours after the arrival of the patient and revealed a mobile thrombus of the aortic arch. The remainder of the visualized aortic arch did not present atherosclerotic plaque. Secondarily, ischaemia of the right superior limb was diagnosed probably cause by emboli originating in the aortic thrombus appeared. The patient died three days later after her arrival, because of neurologic sequelae of the cerebral embolic events. This clinical case underlines the concept that the diagnosis of drug intoxication must remain a diagnosis of elimination. The thrombosis of the aortic arch is a rare pathology in intensive care units. In the presence of unexplained ischaemic stroke and an peripheral emboli, the thrombosis of the aortic arch should be suspected.