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Stroke secondary to multiple spontaneous cholesterol emboli
M Pascual1, J M Baumgartner, H Bounameaux
1Department of Medicine, University Hospital of Geneva, Switzerland.
Insights
A 49-year-old diabetic patient experienced a stroke due to cholesterol emboli from a carotid artery plaque. This case highlights a rare presentation of atheroembolic disease, emphasizing the potential for stroke.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pathology
Background:
- Cholesterol embolization syndrome (CES) typically presents with renal failure, hypertension, and skin ulcerations, primarily associated with atheromatous aortic disease.
- Cerebral involvement, specifically stroke, is an uncommon manifestation of CES.
Observation:
- A 49-year-old diabetic male presented with regressive stroke, aphasia, and right-sided hemiparesis.
- Cerebral emboli in the left paraventricular cortex were identified, alongside cholesterol emboli in the left eye ground.
- An atheromatous plaque was detected at the ipsilateral carotid bifurcation.
Findings:
- The cerebral emboli were presumed to be cholesterol crystals originating from the carotid plaque.
- Neurologic improvement occurred after treatment with low-dose aspirin (100 mg/day).
- One-year follow-up showed clinical stability, recurrent retinal cholesterol emboli, and an unchanged carotid plaque.
Implications:
- This case underscores that stroke can be a rare but significant manifestation of cholesterol embolization syndrome.
- Increased use of invasive vascular procedures may lead to a higher incidence of such embolic events.
- Further research is warranted to understand and prevent cerebral complications of atheroembolic disease.
Abstract:
We describe one male, 49-year-old diabetic patient in whom regressive stroke with aphasia and right-sided hemiparesia was related to multiple small emboli in the left paraventricular cortex. Simultaneous presence of several cholesterol emboli in the left eye ground and detection of an atheromatous plaque at the homolateral carotid bifurcation let assume that the cerebral emboli originated from that plaque and also consisted of cholesterol crystals. The patient was discharged on low-dose aspirin (100 mg/day) after neurologic improvement. Follow-up at one year revealed clinical stability, recurrence of the cholesterol emboli at the eye ground examination and no change of the carotid plaque. Cholesterol embolization with renal failure, hypertension and peripheral arterial occlusions causing skin ulcerations is classical in case of atheromatous aortic disease but stroke has rarely been reported in this syndrome. However, more frequent use of invasive procedures (arteriography, transluminal angioplasty, vascular surgery) or thrombolytic treatment might increase its incidence in the near future.