Abstract
An 80-year-old male was admitted to hospital in a coma, suffering from atrial fibrillation and oculomotor nerve palsy. MRI diffusion weighted imaging revealed a high intensity area in the left cerebellar hemisphere on the first day. The patient was diagnosed as having top of the basilar syndrome. Anticoagulant and antidysrhythmic therapy was administered to prevent recurrence of the embolism, and the patient's heart resumed a sinus rhythm on the 15th day. On the 31st day, he experienced sudden severe abdominal pain and nausea and died of shock with metabolic acidosis at 8 hours after the onset. An autopsy disclosed that the patient had an embolic occlusion of the superior mesenteric artery with intestinal necrosis. This acute mesenteric ischemia was inferred to have been the cause of death. Since ulceration and parietal thrombus were found in the aortic arch, but no thrombus was observed in the atrium of the heart, the aortic arch lesion was assumed to have been the origin of the embolic occlusion. It is concluded therefore that sudden onset of severe abdominal pain followed by shock could be a sign of acute mesenteric ischemia in patients with embolic stroke, and aortic arch plaque may represent one of the origins.
