Lacunar infarctions due to cholesterol emboli.
OBJECTIVE
Hypertension is commonly considered the major cause of lacunar infarctions. However, in some cases, it has been suggested that lacunes could be caused by cerebral emboli from cardiac or carotid sources. Cholesterol cerebral emboli have been rarely reported as a cause of lacunes.


METHODS
We describe a 79-year-old patient with a progressive multi-infarct dementia who developed transient motor aphasia and paresis of the right arm. Computed tomography showed lacunar infarcts in the right caudate nucleus, left thalamus, and left putamen, as well as an old right frontal infarction. Neuropathological examination demonstrated no prominent vascular hyalinosis, but did show multiple cholesterol emboli occluding small arteries around lacunar infarcts and leptomeningeal arteries near cortical infarcts. The cholesterol material presumably originated in the extended atheromatous changes along the aortic arch.


CONCLUSIONS
Our report confirms that lacunes can be caused by cholesterol emboli in some patients. Small cerebral emboli should not be overlooked as a cause of lacunes.
Laloux
P
P
Department of Neurology, Mont-Godinne Hospital (University of Louvain), Yvoir, Belgium.
Brucher
J M
JM
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002536:Cerebral Arteries; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000473:pathology; D002784:Cholesterol; D004617:Embolism / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D014057:Tomography, X-Ray Computed
D002784:Cholesterol