Transesophageal echocardiographic detection of aortic arch disease in patients with cerebral infarction.
OBJECTIVE
Ulcerated plaques in the aortic arch are frequent autopsy findings in patients with cerebral infarctions, particularly those of unknown cause. It has been suggested that they could be a source of cerebral emboli. Using transesophageal echocardiography, we prospectively studied 12 consecutive patients with cerebral infarction of undetermined cause after noninvasive workup to evaluate the frequency of aortic plaques or mural thrombi that could embolize in cerebral arteries.


RESULTS
Six patients (50%) had an intraluminal echogenic mass of the aortic arch, mainly located at the junction of the ascending aorta and arch. This material was pedunculated (in one patient) or broad based (in five patients) with a markedly irregular surface and intraluminal extension from 3 to 15 mm. In addition, we found cholesterol emboli in two of the four patients who underwent quadriceps biopsy.


CONCLUSIONS
These results show that transesophageal echocardiography has capabilities in detecting such lesions and point to the aortic arch as a possible source of cerebral emboli in patients with cerebral infarction of unknown cause.
Amarenco
P
P
Service de Neurologie, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.
Cohen
A
A
Baudrimont
M
M
Bousser
M G
MG
D000368:Aged; D000369:Aged, 80 and over; D001015:Aortic Arch Syndromes / Q000150:complications / Q000175:diagnosis*; D001706:Biopsy; D002544:Cerebral Infarction / Q000150:complications*; D002784:Cholesterol; D004452:Echocardiography / Q000379:methods*; D004617:Embolism / Q000473:pathology; D004947:Esophagus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000098:blood supply / Q000473:pathology; D011446:Prospective Studies
D002784:Cholesterol