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MES, what a mess! A modern version of Russian roulette

Department of Neurology, University Hospital Münster, Münster, Germany

Correspondence to:
Professor E B Ringelstein, Department of Neurology, University Hospital Münster, Albert-Schweitzer-Str 33, D-48149 Münster, Germany; ringels@uni-muenster.de

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

Arterial embolic sources are "smoking guns", and microembolic signals (MES) detected in the middle cerebral artery by transcranial ultrasound reflect the patient’s risk of receiving another "shot". In their paper, Iguchi and colleagues¹ convincingly demonstrated that a considerable proportion of acute stroke patients with MES detected 48 h after stroke onset are at high risk of additional consecutive ischaemic brain lesions despite state-of-the-art anticoagulation or antiplatelet therapy (see page 253). This supports the idea of embolic sources acting as a sword of Damocles, and again raises the discussion of intensified antithrombotic strategies in stroke patients positive for MES.

In 1999, Molloy and Markus² demonstrated that the detection of MES is related to a higher risk of stroke and transient ischaemic attack in patients with carotid artery stenosis. In a recently published paper by Nakajima and colleagues,³ a higher number of ischaemic lesions on diffusion weighted imaging were found . . . [Full text of this article]

Relevant Article

Microembolic signals at 48 hours after stroke onset contribute to new ischaemia within a week

Y Iguchi, K Kimura, K Kobayashi, Y Ueno, K Shibazaki, and T Inoue
J. Neurol. Neurosurg. Psychiatry 2008 79: 253-259. [Abstract] [Full Text] [PDF]