Recurrent cholesterol embolism as a cause of fluctuating cerebral symptoms.

Embolic occlusion of a large cerebral artery com- monly results in easily recognized cerebral infarction. When arterioles are involved by small emboli there may be only transient disturbances of neuro- logical function, as, for example, when attacks of monocular blindness occur in association with recur- rent retinal artery embolism (Fisher, 1959; Russell, 1961, 1963). A third, less common clinical ex- pression of cerebral embolism is that of a fluctuating but increasing neurological deficit. The present report concerns two cases of this last kind in which multiple embolism of small arteries by cholesterol crystals was demonstrated at necropsy. CASE REPORTS CASE 1 A 69-year-old man (N. H. No. A16218) was ad- mitted (Dr. William Gooddy) on 1 February 1964 with a three weeks' history of fluctuating confusion. He was known to have been hypertensive (B.P. 220/110 mm. Hg) five years earlier. For four years he had been rather lethargic, and for six months he was more irritable than Platelet count 179,000/c.mm., clotting time 5 minutes, bleeding time 3f mninutes. A chest radiograph (supine) showed rounding of the left border of the heart, together with unfolding of the aorta and calcification of the t89 Protected by copyright.