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MES, what a mess! A modern version of Russian roulette
  1. Erich Bernd Ringelstein,
  2. Ralf Dittrich
  1. Department of Neurology, University Hospital Münster, Münster, Germany
  1. Professor E B Ringelstein, Department of Neurology, University Hospital Münster, Albert-Schweitzer-Str 33, D-48149 Münster, Germany; ringels{at}

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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 …

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