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Steroid-responsive leucoencephalopathy due to cholesterol embolism

Correspondence to:
Correspondence to:
Professor P Laloux
Department of Neurology, Mont-Godinne University Hospital, Avenue Therasse 1, B-5530 Yvoir, Belgium; laloux@nchm.ucl.ac.be

The first 150 words of the full text of this article appear below.

The paper by Andreux et al¹(see p 180) reported the first case of multiple cholesterol emboli responsible for a steroid-responsive encephalopathy.

Showers of cholesterol emboli are dislodged from disrupted, ulcerated carotid or aortic atheromatous plaques. The aortic arch is, however, the main source. In the French Study of Aortic Plaques in Stroke, after adjustment for the presence of carotid stenosis, atrial fibrillation, peripheral arterial disease and other risk factors, aortic plaques 4 mm thickness were found to be an independent risk factor for recurrent stroke.² Cholesterol embolisation can occlude retinal arteries and/or multiple small deep and leptomeningeal brain arteries 17–585 µm in diameter. Lacunar infarcts, commonly due to lipohyalinosis, can also be caused by cholesterol emboli occluding the small deep perforating arteries.³ Diagnosis may be difficult, especially in patients presenting fluctuating, but also progressive, cerebral symptoms such as confusion and disorientation. Recurrent amaurosis fugax or transient ischaemic . . . [Full text of this article]

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