Abstract Details

Title A case demonstrating the role of transesophageal echocardiography in Embolic Strokes of Undetermined Source

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-020

Objective To present the case of a 79-year-old woman with acute ischemic stroke found to have aortic arch atheroma, and to discuss the role of transesophageal echocardiogram in the diagnostic evaluation of Embolic Strokes of Undetermined Source (ESUS).

Background Diagnostic evaluation to determine the etiology of an acute ischemic stroke is crucial to minimize the risk of recurrence. Unfortunately, ESUS still represent a significant proportion of ischemic strokes, and their optimal management remains uncertain. Currently, transesophageal echocardiography is not required to classify a stroke as ESUS.

Design/Methods Case report

Results A 79-year-old right-handed woman with a past medical history of hypertension and hyperlipidemia presented with acute right-sided weakness, right facial droop, and aphasia. She was found to have an occlusion of the M1 segment of the left middle cerebral artery. She received intravenous thrombolysis and underwent a successful mechanical thrombectomy with good neurological recovery. Transthoracic echocardiography performed as part of the stroke work-up revealed a severely dilated left atrium. We recommended loop recorder implantation to evaluate for occult paroxysmal atrial fibrillation. To investigate further for left atrial appendage thrombus, we decided to proceed with transesophageal echocardiography, which in fact demonstrated complex atherosclerotic plaque with a highly mobile atheroma in the distal aortic arch. She was started on dual antiplatelet and high-dose statin therapy.

Conclusions This case demonstrates the utility of transesophageal echocardiography to evaluate for cardioembolic sources in patients with acute ischemic stroke as the findings may have management implications. Multiple potential sources of thromboembolism may co-exist and it is important to consider further investigations even after one explanatory abnormality is discovered.

Authors/Disclosures
Melissa Ng, MB BChir PRESENTER	Dr. Ng has nothing to disclose.
Adina Wise, MD	Dr. Wise has nothing to disclose.
Carolyn D. Brockington, MD (St. Luke's Roosevelt Hospital)	No disclosure on file
John Liang, MD (Mount Sinai Health System)	Dr. Liang has nothing to disclose.

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