Large aortic arch mural thrombus in non-atherosclerotic thoracic aorta—a rare cause of stroke in the young

A 43-year-old Indian woman was admitted to the intensive care unit, with large cerebellar infarction. A brain CT scan showed a large non-haemorrhagic infarct involving the vermis and cerebellar hemispheres. Transesophageal echocardiography and CT angiography demonstrated a large mural aortic thrombus. No evidence of cardiac or vascular pathology was present. The patient had a high risk for surgical intervention and was treated with anticoagulation. Follow-up imaging 2 weeks later showed complete resolution of the thoracic aortic thrombus. This case report emphasises that imaging of the great vessels of the neck and transesophageal echocardiography should be included in ischaemic stroke work up. A thoracic aortic thrombus should always be considered in young patients with unexplained stroke or peripheral embolism; the condition can be treated effectively with anticoagulation.