Abstract
Case 1 involved a 77-year-old woman with diabetes mellitus. She was aware of right hemiparesis, and was admitted on the next day. Case 2 involved a 66-year-old man with diabetes mellitus. He was admitted because of the rapid progression of systemic edema, gait disturbance, and dysarthria. Right hemiparesis and sensory disturbance developed 3 days after the admission. Both cases were diagnosed as having nephrotic syndrome with bilateral multiple brain infarction on the initial MRI diffusion-weighted images. In case 1, bilateral vertebral artery stenosis was observed. In both cases, atrial fibrillation was not observed, but left atrial spontaneous echo contrast and aortic arch complicated lesions were revealed in transesophageal echocardiography. Hypercoagulant state due to nephrotic syndrome could be also related with thrombus formation in the atherosclerotic lesion or left atrium, and anticoagulant therapy was continued. In the previous reports of nephrotic syndrome with brain infarction, few cases underwent transesophageal echocardiography (TEE), however, the etiology of their infarction was likely to be embolism in many cases. Left atrial spontaneous echo contrast and aortic arch complicated lesion might be frequent in cases with both nephrotic syndrome and brain infarction especially in the middle-aged and elderly patients, and TEE should be required in such cases.
