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Cerebral embolic infarcts (embolic shower)

Case contributed by Dr Bruno Di Muzio


Unwell patient in ICU.

Patient Data

Age: 45 years
Gender: Female

Multiple small foci of brain infarction involving all the large vascular territories and mostly in a peripheral/cortical distribution. A cluster of susceptibility foci in the right parietal lobe in keeping with micro hemorrhages. MRA circle of Willis is normal. 

Case Discussion

The imaging appearances of multiple infarcts in almost all the major vascular territories, including the posterior fossa, are those of shower emboli from a central source. 

Generally, causes that could explain cardiac embolism to the brain are 1

  • blood stasis and thrombus formation in an enlarged left cardiac chamber: e.g. a ventricular aneurysm, atrial fibrillation, etc.
  • valvular surface releasing abnormal materials: e.g. mitral calcific degeneration, nonbacterial thrombotic endocarditis, infective endocarditis, etc.
  • paradoxical embolism (abnormal communication in between the venous to the arterial circulation): e.g. patent foramen ovale, pulmonary AVMs, etc.

Atrial fibrillation, which is the commonest sustained cardiac arrhythmia. is considered the major source for cardioembolic stroke 1

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