Recurrent cerebral embolism in cardiac amyloidosis

Cardiac involvement is common in systemic amyloidosis. The most frequent cardiovascular manifestations are congestive heart failure and arrhythmias. Embolic complications often occur after the onset of these symptoms. We report a 46-year-old woman with systemic amyloidosis, who sustained two middle cerebral artery strokes and shortly after developed symptoms of cardiac and renal failure with a rapid fatal course. Postmortem findings revealed mural thrombi in the left atrium as the source of embolism to the brain, to the spleen, and to the left kidney. As no evidence of congestive heart failure or arrhythmias was found in the beginning, the mechanism of mural thrombosis was probably an alteration in the thrombogenicity of the endocardium itself.