J Clin Neurol.  2005 Apr;1(1):92-96. 10.3988/jcn.2005.1.1.92.

Embolic Infarction Associated with Cardiac Amyloidosis

• Cho KH
• Cho YM
• Kim JS

• KMID: 2287718
• DOI: http://doi.org/10.3988/jcn.2005.1.1.92

Abstract

Embolic cerebral infarction due to cardiac amyloidosis is rare. We report two patients with amyloidosis who developed cerebral infarcts. These embolic infarcts were probably related to cardiac involvement of amyloidosis, which was based on results of myocardial biopsy (Patient 1), and kidney biopsy and characteristic echocardiographic features including granular sparkling, restrictive cardiomyopathy and the presence of mural thrombus (Patient 2). Diffuse amyloid infiltration of the heart may have lead to impairment of myocardial function and subsequent mural thrombosis. Cardiomyopathy due to cardiac amyloidosis should be recognized as one of the causes of cardioembolic infarction.

Keyword

Stroke; Cardiomyopathy; Amyloidosis; Embolism

MeSH Terms

Amyloid
Amyloidosis*
Biopsy
Cardiomyopathies
Cardiomyopathy, Restrictive
Cerebral Infarction
Echocardiography
Embolism
Heart
Humans
Infarction*
Kidney
Stroke
Thrombosis
Amyloid

Figure

• 

  Figure 1 Endomyocardial biopsy findings of patient 1. (A) Deposition of amyloid is shown (arrow) (H&E ×200). (B) "Apple-green" birefringence under polarized light (Congo red stain ×400).

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  Figure 2 T2-weighted MRI of patient 1 shows cerebral infarcts in the right basal ganglia and corona radiata. MRA reveals near total occlusion or severe stenosis of the right distal M1 and proximal M2 portion of the MCA.

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  Figure 3 Kidney biopsy findings of patient 2. (A) Deposition of amyloid is shown in blood vessels of medulla (arrows) (H&E ×200). (B) "Apple-green" birefringence under polarized light (Congo red stain ×200).

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  Figure 4 T2-weighted MRI of patient 2 shows cerebral infarcts in the right PCA and left MCA (arrow) territories.

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  Figure 5 Echocardiographic findings of patient 2. Left ventricular wall is symmetrically thickened (arrows), and the size of the left ventricular cavity is small. Also observed are thickened interventricular septum, enlarged left atria and slightly increased myocardial echogenecity.

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