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PubMed1991

An interesting case presentation: ultrasound diagnosis of primary atrial thrombosis associated with brain infarctions.

A premature infant with nonbacterial endocardial thrombosis and embolization of the cerebral circulation is presented. The patient was born at 32 weeks with a birthweight of 1480 g. Pregnancy was complicated by toxemia and placental infarctions. Echocardiographic examination by 12 hours after birth revealed a large mass in the right atrium compatible with endocardial thrombus. Follow-up echocardiograms showed a small mass in the left atrium and a decrease of the right atrial mass by day 7. Echoencephologram studies were normal on day 1. An echodense area in the subcortical white matter was seen by day 2. Other echodensities were detected by day 10. Computerized tomography studies showed areas of decreased attenuation in both hemispheres. Lung perfusion scan and renal-liver ultrasound studies were normal. All these cerebral and cardiac lesions were asymptomatic. Real-time ultrasonography is useful to diagnose asymptomatic endocardial thrombosis and its cerebral complications in premature infants.

Cerebral Infarction↗
PubMed2002

[Multiple cerebral infarcts caused by spontaneous, synchronous cholesterol embolisms].

We report on a 68-year-old patient who was admitted with hemiparesis and disorientation. Computed tomography showed several old, mostly lacunar infarcts. One week after admission, the patient became comatose. A repeat computed tomography revealed several new hypodense lesions in both hemispheres compatible with acute cerebral infarctions. Autopsy confirmed the diagnosis of numerous acute encephalomalacias of the same age which were found in different territories of the anterior cerebral circulation. Histologic examination showed the extraordinary result of multiple cholesterol emboli with a maximum in the peripheral leptomeningeal vessels. The source of the emboli was severe atherosclerosis with an ulcerated and thrombotic surface of the aorta and both carotid arteries. This case is remarkable because of its severe and synchronous emboli of cholesterol in several different cerebral territories. One has to suspect a so far unknown physical or metabolic factor responsible for the shower of emboli.

Aged↗