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 …