Multiple Hirninfarkte durch spontane, synchrone Cholesterinembolien

Abstract

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.