The authors describe 2 patients with multiple cerebral infarcts and hemorrhagic trans formation caused by artery-to-artery emboli. Ulcerated plaques with free-floating thrombus adherent to the plaque were detected at the carotid bifurcation by duplex sonography. No other embolic source could be found. One patient developed an occipital infarction due to carotid emboli passing through a fetal-type posterior communicating artery. Both patients recovered well without recurrence of stroke or transient ischemic attack with antiplatelet treatment only. Follow-up carotid duplex sonography showed disappearance of floating thrombus in 1 patient and consolidation of the lesion in the other.
Get full access to this article
View all access options for this article.
References
1.
Fisher M., Blumenfeld AM, Smith TW: The importance of carotid artery plaque disruption and hemorrhage . Arch Neurol44:1086-1089, 1987 .
2.
Arning C., Herrmann HD: Floating thrombus in the internal carotid artery disclosed by B-mode ultrasonography . J Neurol235:425-427, 1988.
3.
Kotval PS, Barakat K.: Doppler and M-mode sonography of mobile carotid plaque (letter). Am J Radiol153:433-434, 1989.
Wasserman BA , Haacke EM, Li D.: Carotid plaque formation and its evaluation with angiography, ultrasound, and MR angiography. J Magnetic Resonance Imaging4:515-527, 1994.
6.
Sitzer M., Muller W., Siebler M., et al: Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis. Stroke26:1231-1233, 1995.
7.
Chan JL, Lee TH, Chen ST, et al: Recurrent stroke onset precipitated during carotid ultrasound examination in a case of severe internal carotid artery stenosis with soft, moving plaques. In: Recent Advances in Neurosonology, ed. by Oka M, et al. Amsterdam : Elsevier Science Publishers, 1992 , pp 441-443.
8.
Mochizuki S. , Takayama S., Nishiyama T., et al: Two cases of protruding atherosclerotic plaque with mobile projections in the aortic arch . Int Med32:777-780, 1993.
9.
Horowitz DR, Tuhrim S., Budd J., et al: Aortic plaque in patients with brain ischemia: Diagnosis by trans-esophageal echocardiography. Neurology42:1602-1604, 1992.
10.
Norris JW, Krajewski A., Bornstein NM, et al: Carotid plaque disruption (letter). Arch Neurol46:605, 1989.
11.
Karalis DG, Chandrasekaran K., Victor MF, et al: Recognition and embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol17:73-78, 1991.
12.
Lennihan L. , Kupsky WJ, Mohr JP, et al: Lack of association between carotid plaque hematoma and ischemic cerebral symptoms. Stroke18:879-881, 1987.
13.
Chang YJ, Lin SK, Ryu SJ, et al: Common carotid artery occlusion: Evaluation with duplex sonography . AJNR16:1099-1105, 1995 .
14.
Lin SK, Ryu SJ, Chu NS: Carotid duplex and transcranial color-coded sonography in evaluation of carotid-cavernous sinus fistulas. J Ultrasound Med13:557-564, 1994.
Martin R., Bogousslavsky J., Miklossy J., et al: Floating thrombus in the innominate artery as a cause of cerebral infarction in young adults. Cerebrovasc Dis2:177-181, 1992.
17.
Combe J., Poinsard P., Besancenot J., et al: Free-floating thrombus of the extracranial internal carotid artery. Ann Vasc Surg4:558-562, 1990.
18.
Gortler M., Goldmann A., Mohr W., et al: Tissue characterization of atherosclerotic carotid plaques by MRI. Neuroradiology37:631-635, 1995.
19.
Torvik A., Svindland A., Lindboe CF: Pathogenesis of carotid thrombosis. Stroke20:1477-1483, 1989.
20.
Mazzone AM, Urbani MP, Picano E., et al: In vivo ultrasonic parametric imaging of carotid atherosclerotic plaque by videodensitometric technique. Angiology46:663-672, 1995.
21.
Pessin MS, Kwan ES, Scott RM, et al: Occipital infarction with hemianopsia from carotid occlusive disease. Stroke20:409-411, 1989.
22.
Cohen SN: Occipital infarction with hemianopsia from carotid occlusive disease (letter). Stroke20:1433-1434, 1989 .
23.
Bruno A., LaKind E.: Occipital infarction: Carotid artery and cardiac findings . 2:70-73, 1992.
Yasaka M., Yamaguchi T., Yonehara T., et al: Recurrent embolization during intravenous administration of tissue plasminogen activator in acute cardioembolic stroke. Angiology45:481-485, 1994.
27.
Bautista Red : Embolic stroke following thrombolytic therapy for myocardial infarction in a patient with preexisting ventricular thrombi . Stroke26:324-325, 1995.
28.
Hart RG: Cardiogenic embolism to the brain. Lancet339:589-594, 1992.
