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(Circulation. 1999;100:1009-1010.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Cerebral Arterial Embolism From a Protruding Atheroma of the Aortic Arch After a Nonpenetrating Chest Trauma

Roberto Corti, MD; Mario Alerci, MD; Carlo Tosi, MD; Paolo Tutta, MD; Thomas Hany, MD; Augusto Gallino, MD

From the Divisions of Vascular Medicine and Cardiology (R.C., P.T., A.G.) and Radiology (M.A.), Ospedale San Giovanni, Bellinzona; the Division of Neurology (C.T.), Ospedale Civico, Lugano; and the MRI Center, Department of Radiology (T.H.), University Hospital, Zurich, Switzerland.

Correspondence to Prof Augusto Gallino, Division of Vascular Medicine and Cardiology, Ospedale San Giovanni, 6500 Bellinzona, Switzerland. E-mail agallino@bluewin.ch

	Introduction

 
A60-year-old bricklayer was referred to our hospital because of acute bilateral blindness, vertigo, and bifrontal headache occurring within 10 seconds after a violent shock to the right shoulder while he was trying to open a closed door. On physical examination, the patient presented with bilateral tubular vision and strabismus with diplopia consistent with the clinical diagnosis of a "top of the basilar" syndrome. This syndrome is generally associated with an acute transitory embolic occlusion at the bifurcation of the basilar artery with consequent possible ischemia in the mesencephalic and occipital region. Extensive investigations to detect possible embolic causes (duplex-ultrasound; magnetic resonance angiography of the carotid, vertebral, and basilar arteries; transthoracic echocardiography) were negative.

Transesophageal echocardiography, however, showed multiple atheromatous plaques of the aortic arch with mobile peduncles (Figure 1, arrows). Spiral CT confirmed the presence of atherosclerotic plaques of the aortic arch, one located opposite the left subclavian artery (Figure 2).

View larger version (117K): [in this window] [in a new window]   Figure 1. Transesophageal echocardiography shows details of a large calcified plaque (22x18 mm) of aortic arch with a mobile peduncle (4x2 mm) on top of plaque. Curved arrows on both sides of the mobile peduncle indicate movement of the peduncle into the aortic lumen.

View larger version (119K): [in this window] [in a new window]   Figure 2. Spiral CT of aortic arch shows presence of multiple atherosclerotic plaques, one of them located just opposite left subclavian artery. CCA indicates common carotid artery.

Virtual endoluminal reconstruction by magnetic resonance angiography shows the roof of the aortic arch with the origin of the left subclavian artery . . . [Full Text of this Article]