Register for email alerts and news feeds:
This journal | BMJ Group
rss
Published 16 February 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.2007.123232]
Copyright © 2009 by the BMJ Publishing Group Ltd.

Images in...

Identifying aortic plaque inflammation as a potential cause of stroke

R R Moustafa1, D Izquierdo2, P L Weissberg3, J-C Baron1, E A Warburton1

1 Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
2 Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
3 Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK

Correspondence to:
rrmm2{at}cam.ac.uk

Inflammatory activity within atherosclerotic lesions is associated with plaque rupture and embolic events,1 and can be detected non-invasively with 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET).2

A 70-year-old hypertensive man presented with sudden mild right hemiparesis and dysarthria. A CT scan of the head was normal. There was no cardiac source of embolism, and ultrasound and catheter angiography revealed ~75% stenosis of the left carotid bifurcation. Imaging with FDG-PET and MRI to clarify the embolic source2 (fig 1) suggested that the "culprit" lesion was inflamed aortic atheromata rather than the presumed symptomatic tight carotid stenosis. This novel pathophysiological approach can add to the aetiological work-up of stroke and has potential in guiding management.


Figure 1
View this figure (64K):
in this window | in a new window | PowerPoint for Teaching
 

Figure 1 Co-registered axial FDG-PET and MRI scans of the neck (A,B) and chest (C–E), showing minimal tracer uptake in the ipsilateral carotid artery (arrow) and high uptake into an eccentric plaque in the arch of the aorta. (F) Schematic of chest MRI showing the aortic arch (A) with plaque, lungs (L), superior vena cava (S), trachea (T) and vertebral body (V).

 

This article has been adapted from Moustafa R R, Izquierdo D, Weissberg P L, Baron J-C, Warburton E A. Identifying aortic plaque inflammation as a potential cause of stroke Journal of Neurology, Neurosurgery and Psychiatry 2008;79:236

Competing interests: None.

REFERENCES

  1. Ross, R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999;340:115–26.[Free Full Text]
  2. Davies, JR, Rudd, JH, Fryer, TD, et al. Identification of culprit lesions after transient ischemic attack by combined 18F fluorodeoxyglucose positron-emission tomography and high-resolution magnetic resonance imaging. Stroke 2005;36:2642–7.[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This Article

Services
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) -   become a fellow  today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts  so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog