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In August 1999, an 81-year old woman suffered back pain, which gradually improved within 2 weeks. On the morning of January 7 2000, she was admitted to our hospital with speech disturbance. Magnetic resonance imaging (MRI) demonstrated a cortical infarct in her left frontal lobe. Transesophageal echocardiography (TEE) revealed an elevated lesion (2cm × 5cm) in the descending aorta, which had three oscillating flaps and two pseudolumens. Computed tomography (CT) showed severe calcification in the aortic wall, but no aortic dilatation near this lesion. This elevated lesion showed severe atherosclerotic changes and an intimal defect, but neither dilatation nor dissection of the aortic wall had occurred, suggesting the lesion was a penetrating atherosclerotic ulcer (PAU) . Hematological examination in August 1999 disclosed a hypercoagulable state (TAT 558 ng/ml, F1+2 8.6 nmol/l) . Three months after the onset of the cerebral infarction, the pseudolumen had expanded markedly. We consider that the presence of a PAU may be another risk factor for cerebral infarction.
日本脳神経超音波学会の論文

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